Provider Demographics
NPI:1689545576
Name:EDWARDS, PHILLIP (PLMHP, PLADC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3542
Mailing Address - Country:US
Mailing Address - Phone:402-991-0611
Mailing Address - Fax:402-991-6228
Practice Address - Street 1:12035 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3542
Practice Address - Country:US
Practice Address - Phone:402-991-0611
Practice Address - Fax:402-991-6228
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2361101YA0400X
NE14638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)