Provider Demographics
NPI:1124324603
Name:EDMONDS, JENNIFER EYVETTE (MA, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EYVETTE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-1135
Mailing Address - Country:US
Mailing Address - Phone:724-263-3091
Mailing Address - Fax:724-843-0818
Practice Address - Street 1:1008 7TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4530
Practice Address - Country:US
Practice Address - Phone:724-843-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health