Provider Demographics
NPI:1154959468
Name:KAU, JADE K
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:K
Last Name:KAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3894 SATURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1922
Mailing Address - Country:US
Mailing Address - Phone:805-296-6011
Mailing Address - Fax:
Practice Address - Street 1:3894 SATURN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1922
Practice Address - Country:US
Practice Address - Phone:805-296-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 106E00000X
CA11847101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst