Provider Demographics
NPI:1740635515
Name:EDIE, LUZ
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:EDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8654 E PLACITA PUEBLO BONITO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2676
Mailing Address - Country:US
Mailing Address - Phone:517-285-7679
Mailing Address - Fax:
Practice Address - Street 1:2502 N DODGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2672
Practice Address - Country:US
Practice Address - Phone:520-721-1887
Practice Address - Fax:520-344-8892
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014845101Y00000X
AZLPC-18415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor