Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003079542 |
---|---|
Provider Name | Ms. Jefri Susan Edwards I |
First Address | Oceanside, CA 92054-5314 |
Second Address | Oceanside, CA 92054-5314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2008 |
Last Update Date | 04/07/2008 |