Individual
MR. JERRY MITCHELL EDMONDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
2849 HAMPTON AVE, SAINT LOUIS, MO 63139-2626
(314) 910-3099
Mailing address
2849 HAMPTON AVE, SAINT LOUIS, MO 63139-2626
(314) 910-3099
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2008012530
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008012530
LICENSED NUMBER FOR STATE OF MISSOURI LICENSED PROFESSIONAL COUNSELOR
MO
Enumeration date
06/22/2008
Last updated
06/03/2014
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