Provider Demographics
NPI:1912534199
Name:EDWARDS, BARBARA MICHELLE (LCSW, CADAC III MATS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW, CADAC III MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15671 N 1190TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-4152
Mailing Address - Country:US
Mailing Address - Phone:217-264-3260
Mailing Address - Fax:
Practice Address - Street 1:601 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47885-1303
Practice Address - Country:US
Practice Address - Phone:812-244-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN330009277A104100000X
IN34010188A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker