Jedediah Heath Wilson, MED, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

5501 Delmar Blvd Ste B300
Saint Louis, MO 63112-3078

Phone

(314) 469-4908

NPI assigned

Mar 21, 2022

Last updated

Sep 9, 2024By 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 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

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.

• Behavioral Health Response, Inc

  • Counselor
  • Saint Louis, MO
  • NPI 1023546967
  NPD
• Provident Inc.

  dba Provident Behavioral Health

  • Mental Health Counselor
  • Saint Louis, MO
  • NPI 1710023791
  NPD (past)

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

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1679222392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6705 PARKWOOD PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631162153",
            "telephone_number": "312-513-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 DELMAR BLVD STE B300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631123078",
            "telephone_number": "314-469-4908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12141 LaDue Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418120",
            "country_code": "US",
            "telephone_number": "314-878-4340",
            "fax_number": "314-842-2552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEDEDIAH",
        "middle_name": "HEATH",
        "credential": "MED, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-21",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2022014908",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deann Wilson, PNP-BC
• Denise Lyvette Wilson, LCSW
• Ebony Wilson
• Harlan Joseph Wilson, D.D.S.
• Jane Lewis Wilson, OTR/L
• Jeffrey S Wilson, RPH
• Jenna Leigh Wilson, MD
• Joann M Wilson, AGNP
• John Wilson, MD
• Joshua Brockway Wilson, MD

• Professional Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.