Provider Demographics
NPI:1851378814
Name:MULDROW, EDWARD J III (LCSW,PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:MULDROW
Suffix:III
Gender:M
Credentials:LCSW,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7524 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-6624
Mailing Address - Country:US
Mailing Address - Phone:832-233-2791
Mailing Address - Fax:281-480-2407
Practice Address - Street 1:1560 W BAY AREA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2667
Practice Address - Country:US
Practice Address - Phone:281-480-2400
Practice Address - Fax:281-480-2407
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333831041C0700X
IL149.0245481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163329901Medicaid
TX0006LJOtherBLUE CROSS
TX163329901Medicaid