Healthcare Provider Details

I. General information

NPI: 1235792508
Provider Name (Legal Business Name): ESCAPINGTHE COM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 LYNDON B JOHNSON FWY STE 120
DALLAS TX
75240-6410
US

IV. Provider business mailing address

6320 LYNDON B JOHNSON FWY STE 120
DALLAS TX
75240-6410
US

V. Phone/Fax

Practice location:
  • Phone: 214-433-2721
  • Fax:
Mailing address:
  • Phone: 214-433-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JEREMY EDGE
Title or Position: OWNER
Credential: LPC
Phone: 214-433-2721