Jeremy R Edge, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

70750 Issued in TX

Practice address

6320 Lyndon B Johnson Fwy Ste 120
Dallas, TX 75240-6410

Phone

(214) 433-2721

NPI assigned

Aug 7, 2017

Reactivated

May 15, 2019

Last updated

Dec 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Escapingthe Com PLLC

  • Mental Health Counselor
  • Dallas, TX
  • NPI 1235792508
  NPD Authorized official

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1053836437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6320 LYNDON B JOHNSON FWY STE 120",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752406410",
            "telephone_number": "214-433-2721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 LYNDON B JOHNSON FWY STE 120",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752406410",
            "telephone_number": "214-433-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGE",
        "first_name": "JEREMY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-07",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "deactivation_date": "2019-05-06",
        "reactivation_date": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "70750",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "70750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edge-MD Illinois, PLLC
• Edge-MD Lake June, PLLC
• Edge-MD Singleton, PLLC
• Edge-MD, PLLC
• Colleen D Edge, MD
• Jennifer Edgemon
• Allison Renae Edgerly, CRNA
• Linda W Edgerton, CPNP-AC
• Edie Hernandez Putt, Psy D, LPC-PC
• Lynn Edinger

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.