Provider Demographics
NPI:1669855003
Name:EGE, JOHN ERIK (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIK
Last Name:EGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 WEATHERED ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6623
Mailing Address - Country:US
Mailing Address - Phone:214-907-4070
Mailing Address - Fax:
Practice Address - Street 1:1404 WEATHERED ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6623
Practice Address - Country:US
Practice Address - Phone:214-907-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70093101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX868LPZOtherBCBS
TX349719002Medicaid
TX349719001Medicaid