Provider Demographics
NPI:1851020093
Name:EDWARDS, BLAINE LAMONT JR (CMHC)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:LAMONT
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 CEDAR KNLS W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3631
Mailing Address - Country:US
Mailing Address - Phone:435-590-2377
Mailing Address - Fax:
Practice Address - Street 1:936 CEDAR KNLS W
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3631
Practice Address - Country:US
Practice Address - Phone:435-590-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6173792-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health