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General NPI Number Information
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NPI Number | 1922507730
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Entity Type | Organization
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Legal Business Name | EDIFY COUNSELING GROUP LLC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1451 W CYPRESS CREEK RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1961
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Country | US
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Telephone | 888-773-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 W CYPRESS CREEK RD STE 300
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1953
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Country | US
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Telephone | 888-773-3439
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Fax | 888-773-3439
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. JASON-ANTHONY KIRKHAM PRENDERGAST
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Credential | PHD, MBA, BS.
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Telephone | 888-773-3439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17769
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License Number State | FL
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