Healthcare Provider Details

I. General information

NPI: 1578259222
Provider Name (Legal Business Name): JESSICA JAZMIN EDWARDS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 09/28/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N TUSTIN ST # 1006
ORANGE CA
92865-3902
US

IV. Provider business mailing address

2050 NORTH TUSTIN STREET #1006
IRVINE CA
92612-1001
US

V. Phone/Fax

Practice location:
  • Phone: 714-306-8971
  • Fax:
Mailing address:
  • Phone: 714-306-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: