Provider Demographics
NPI:1023097508
Name:EDWARDS, DENNIS WAYNE (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 FERRY ST
Mailing Address - Street 2:HEARTLAND CLINIC
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3047
Mailing Address - Country:US
Mailing Address - Phone:765-446-9898
Mailing Address - Fax:765-446-9424
Practice Address - Street 1:2201 FERRY ST
Practice Address - Street 2:HEARTLAND CLINIC
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3047
Practice Address - Country:US
Practice Address - Phone:765-446-9898
Practice Address - Fax:765-446-9424
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001121A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35001121AOtherMFT LICENSE
IN35001121AOtherMFT LICENSE