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NPI Code Detail

MEDICARE: EDIFY COUNSELING GROUP LLC

MEDICARE: EDIFY COUNSELING GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2261QM0850XAdult Mental Health Clinic/Center
3101YA0400XAddiction (Substance Use Disorder) Counselor
4261Q00000XClinic/Center
5101YP1600XPastoral Counselor
6101YP2500XProfessional Counselor17769FL

General Provider Information

NPI Number : 1922507730
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDIFY COUNSELING GROUP LLC
Provider Business Mailing Address
First Line : 1451 W CYPRESS CREEK RD STE 300
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-1953
Country : US
Telephone Number : 888-773-3439
Fax Number : 888-773-3439
Provider Business Practice Location Address
First Line : 1451 W CYPRESS CREEK RD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-1961
Country : US
Telephone Number : 888-773-3439
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : DR. JASON-ANTHONY KIRKHAM PRENDERGAST
Credential : PHD, MBA, BS.
Telephone Number : 888-773-3439
Provider Enumeration Date : 02/07/2018
Last Update Date : 09/29/2025

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