Provider Demographics
NPI:1699390302
Name:EDWARDS, TRENA LEIGH (LPC-S)
Entity Type:Individual
Prefix:
First Name:TRENA
Middle Name:LEIGH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 WILLOWWICK CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4521
Mailing Address - Country:US
Mailing Address - Phone:318-935-9585
Mailing Address - Fax:318-421-3193
Practice Address - Street 1:3616 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2122
Practice Address - Country:US
Practice Address - Phone:318-779-0104
Practice Address - Fax:318-421-3193
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health