Provider Demographics
NPI:1700909587
Name:EDWARDS, STEPHEN THOMAS II (LMFT, BCPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:EDWARDS
Suffix:II
Gender:M
Credentials:LMFT, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W SADIE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4440
Mailing Address - Country:US
Mailing Address - Phone:813-949-9594
Mailing Address - Fax:813-677-4040
Practice Address - Street 1:306 W SADIE ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4440
Practice Address - Country:US
Practice Address - Phone:813-677-4040
Practice Address - Fax:813-677-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768633100Medicaid