Provider Demographics
NPI:1255822003
Name:EDWARDS, JAMES LYNWOOD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LYNWOOD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 LIVERPOOL ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3425
Mailing Address - Country:US
Mailing Address - Phone:248-515-0924
Mailing Address - Fax:
Practice Address - Street 1:6275 SCHAEFER RD STE 105
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2210
Practice Address - Country:US
Practice Address - Phone:313-652-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician