Jennifer Erin Edmondson, LPC, LADC, CMIII

Primary specialty

CounselorTaxonomy code 101Y00000X

License

5028 Issued in OK

Practice address

1601 S State St Ste 100
Edmond, OK 73013-3507

Phone

(405) 315-7093

NPI assigned

Jun 9, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 3, 2024 through Apr 3, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1033404876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 S STATE ST STE 100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133507",
            "telephone_number": "405-315-7093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 S STATE ST STE 100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133507",
            "telephone_number": "405-315-7093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMONDSON",
        "first_name": "JENNIFER",
        "middle_name": "ERIN",
        "name_prefix": "Mrs.",
        "credential": "LPC, LADC, CMIII",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-09",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "1067",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OK",
            "license": "5028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200370610B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edmond Regional Eye Associates Inc
• Edmond Speech Therapy LLC
• Edmond Urgent Care Inc.
• Edmond Wheelchair Repair & Supply, LLC
• Edmondson Family Therapy
• Edward C Holmes Chiropractic PC
• Edwards Clinic of Chiropractic P.C.
• Paula L. Edwards-Gayfield, LPC
• Carolyn J Edwards-Smith, MA
• Bonnie Marie Edwards

• Counselor in Edmond, OK
• Providers in Edmond, OK by specialty
• Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.