Provider Demographics
NPI:1801173190
Name:LOBDELL, EDWARD RUSSELL (LCPC, LCAC, PCCM)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:RUSSELL
Last Name:LOBDELL
Suffix:
Gender:M
Credentials:LCPC, LCAC, PCCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5017
Mailing Address - Country:US
Mailing Address - Phone:785-830-8238
Mailing Address - Fax:785-830-8238
Practice Address - Street 1:1301 N 47TH ST BLDG A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1705
Practice Address - Country:US
Practice Address - Phone:913-328-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS554101YA0400X
KS2354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)