Provider Demographics
NPI:1043694953
Name:EDMONDS, SHEENA (MS)
Entity type:Individual
Prefix:MS
First Name:SHEENA
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N LAKEWOOD BLVD STE D708
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2552
Mailing Address - Country:US
Mailing Address - Phone:786-838-6388
Mailing Address - Fax:
Practice Address - Street 1:2201 N LAKEWOOD BLVD STE D708
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2552
Practice Address - Country:US
Practice Address - Phone:786-838-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist