Provider Demographics
NPI:1730186438
Name:EDWARDS, GINA COPELAND (MA, PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:COPELAND
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6243
Mailing Address - Country:US
Mailing Address - Phone:541-525-2332
Mailing Address - Fax:
Practice Address - Street 1:1679 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4013
Practice Address - Country:US
Practice Address - Phone:541-525-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16654101YM0800X
ORC4416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health