Provider Demographics
NPI:1427816644
Name:JADE CLINICAL SUPERVISION AND CONSULTATION, LLC
Entity type:Organization
Organization Name:JADE CLINICAL SUPERVISION AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:601-331-6767
Mailing Address - Street 1:4780 I 55 FRONTAGE RD N STE 100-1204
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5542
Mailing Address - Country:US
Mailing Address - Phone:601-331-6767
Mailing Address - Fax:601-861-4909
Practice Address - Street 1:4780 I 55 FRONTAGE RD N STE 100-1204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5542
Practice Address - Country:US
Practice Address - Phone:601-331-6767
Practice Address - Fax:601-861-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty