Provider Demographics
NPI:1700101649
Name:SADDY, EDWARD A (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:SADDY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 HILL COUNTRY DR APT 2103
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5962
Mailing Address - Country:US
Mailing Address - Phone:737-206-1277
Mailing Address - Fax:
Practice Address - Street 1:610 METHODIST ENCAMPMENT RD STE 17
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2834
Practice Address - Country:US
Practice Address - Phone:737-206-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-04
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX64054101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700101649Medicaid