Edris F Lodge, PSYD, LPCT

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

EL860039 Issued in LA

Practice address

5049 Melrose Blvd Ste 1
Baton Rouge, LA 70806-3515

Phone

(225) 933-5553

NPI assigned

May 19, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Edris F Lodge Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1689311797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12171 CANTERBURY PARK DR",
            "city": "GEISMAR",
            "state": "LA",
            "postal_code": "707343270",
            "telephone_number": "225-933-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5049 MELROSE BLVD STE 1",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708063515",
            "telephone_number": "225-933-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LODGE",
        "first_name": "EDRIS",
        "middle_name": "F",
        "credential": "PSYD, LPCT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-19",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "LA",
            "license": "EL860039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDRIS",
            "last_name": "LODGE",
            "middle_name": "F",
            "prefix": "DR.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Cognitive & Behavioral Psychologist in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Cognitive & Behavioral Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.