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Organization

EDGEWOOD CLINICAL SERVICES, P.C.

Active
Other names
LifeStance
Organization subpart
No

Provider details

NPI number
Authorized official
RYAN PARDO (CHIEF LEGAL OFFICER)
(206) 399-1493
Entity
Organization

Contact information

Practice address
2948 ARTESIAN RD STE 112, NAPERVILLE, IL 60564-8559
(630) 428-7890
Mailing address
4800 N SCOTTSDALE RD STE 2500, SCOTTSDALE, AZ 85251-7630
(480) 524-0990

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
103T00000X
Psychologist
Primary
1041C0700X
Clinical Social Worker
149-010253
IL
1041C0700X
Clinical Social Worker
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
11/01/2007
Last updated
03/06/2024
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