Provider Demographics
NPI:1396495768
Name:EDWARDS, JONATHAN F (LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:F
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 FRANKFORD AVE APT 1114C
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5071
Mailing Address - Country:US
Mailing Address - Phone:858-537-7269
Mailing Address - Fax:
Practice Address - Street 1:1002 FRANKFORD AVE APT 1114C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5071
Practice Address - Country:US
Practice Address - Phone:858-537-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health