Individual
ALEXA EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
215 E 50 S, MALAD CITY, ID 83252-2300
(208) 766-2365
(208) 766-2364
Mailing address
115 W 300 N, MALAD CITY, ID 83252-1137
(208) 530-3595
(208) 530-3595
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
35927
ID
Other
Enumeration date
08/18/2016
Last updated
12/12/2016
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