Individual
EDRIS F LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LPCT
Contact information
Practice address
5049 MELROSE BLVD STE 1, BATON ROUGE, LA 70806-3515
(225) 933-5553
Mailing address
12171 CANTERBURY PARK DR, GEISMAR, LA 70734-3270
(225) 933-5553
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
EL860039
LA
171M00000X
Case Manager/Care Coordinator
—
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Other
Enumeration date
05/19/2022
Last updated
07/13/2023
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