Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | P2278 | TN |
N | 103T00000X | Psychologist | P2278 | TN |
Y | 103G00000X | Clinical Psychologist | P2278 | TN |
Y | 103TC0700X | Clinical Psychologist | P2278 | TN |
N | 103G00000X | Clinical Psychologist | PSY-202526 | ID |
N | 103TC0700X | Clinical Psychologist | PSY-202526 | ID |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | P2278 | TN |
N | 103TH0100X | Health Service | P2278 | TN |
NPI | 1346298866 |
---|---|
Provider Name | Dr. Christopher Arlen Edwards |
First Address | Cookeville, TN 38501-3389 |
Second Address | Cookeville, TN 38501-3389 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 15/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3133273 | BC/BS OF TENNESSEE (01) | TN |
3981616 | (05) | TN |