Active NPI
Jacquelyn Renee Edwards, MS, BCBA, LBA
- Behavior Analyst
- Irving, TX
National Provider Identifier
1770099236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 4603
- Practice address
- 400 E Royal LN BLDG 3
Irving, TX 75039-3540 - Phone
- (855) 832-6727
- NPI assigned
- Dec 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 4603 | TX | Primary |
Addresses
Primary practice location
400 E Royal LN BLDG 3
Irving, TX 75039-3540
Mailing address
7108 S Kanner Hwy
Stuart, FL 34997-7462
Phone (512) 632-3263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4603 | TX | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639008000000",
"number": "1770099236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7108 S KANNER HWY",
"city": "STUART",
"state": "FL",
"postal_code": "349977462",
"telephone_number": "512-632-3263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E ROYAL LN BLDG 3",
"city": "IRVING",
"state": "TX",
"postal_code": "750393540",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JACQUELYN",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "MS, BCBA, LBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-20",
"last_updated": "2021-12-09",
"certification_date": "2021-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "TX",
"license": "4603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
- Educare Community Living Corporation - Texas
- Educare Community Living Limited Partnership
- Educare Community Living Limited Partnership
- Educare Community Living Limited Partnership
- Carla Edwards, BCBA
- Mackenzie Edwards, LCSW
- William H Edwards, BCBA
- Eeg Monitoring, LLC
- Effective Therapy Community Support Services Limited Liability Company
- Lakshmi Egappan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.