Provider Demographics
NPI:1821211301
Name:EDWARDS, LEE ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANDREW
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W 31ST ST STE 512
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2026
Mailing Address - Country:US
Mailing Address - Phone:512-694-1322
Mailing Address - Fax:
Practice Address - Street 1:1011 W 31ST ST STE 512
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2026
Practice Address - Country:US
Practice Address - Phone:512-694-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24954103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014JBOtherBLUE CROSS BLUE SHIELD TX