Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 14739 | TX |
N | 101YM0800X | Mental Health Counselor | 14739 | TX |
N | 101YP1600X | Pastoral Counselor | 14739 | TX |
N | 101YP2500X | Professional Counselor | 14739 | TX |
NPI | 1275662553 |
---|---|
Provider Name | Mr. James Lewis Edwards |
First Address | Round Rock, TX 78664-5266 |
Second Address | Round Rock, TX 78664-5266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14739 | LICENSE NUMBER (01) | TX |