Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 31266 | TX |
NPI | 1083621874 |
---|---|
Provider Name | Dr. Lee Thomas Edwards |
First Address | Austin, TX 78751-1915 |
Second Address | Austin, TX 78756-3719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |