Provider Demographics
NPI:1528841939
Name:EDGE SPORTS COUNSELING
Entity type:Organization
Organization Name:EDGE SPORTS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCZEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-810-0199
Mailing Address - Street 1:1201 FANNIN ST STE 262
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6943
Mailing Address - Country:US
Mailing Address - Phone:832-810-0199
Mailing Address - Fax:
Practice Address - Street 1:1201 FANNIN ST STE 262
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6943
Practice Address - Country:US
Practice Address - Phone:832-810-0199
Practice Address - Fax:832-916-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty