Provider Demographics
NPI:1740739101
Name:EDRIS, HILLARY REBEKKA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:HILLARY
Middle Name:REBEKKA
Last Name:EDRIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1323
Mailing Address - Country:US
Mailing Address - Phone:610-944-0445
Mailing Address - Fax:610-944-8834
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1323
Practice Address - Country:US
Practice Address - Phone:610-944-0445
Practice Address - Fax:610-944-8834
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional