Provider Demographics
NPI:1548465560
Name:EDWARDS, AURELIA RENEE (LPCC)
Entity type:Individual
Prefix:MS
First Name:AURELIA
Middle Name:RENEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:AURELIA
Other - Middle Name:RENEE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:316 BIMSON AVE
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1393
Mailing Address - Country:US
Mailing Address - Phone:505-896-1777
Mailing Address - Fax:
Practice Address - Street 1:316 BIMSON AVE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-1393
Practice Address - Country:US
Practice Address - Phone:505-896-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM088861101YP2500X, 101YP2500X
NM0088861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90531329Medicaid