Provider Demographics
NPI:1699560870
Name:SMITH, JADE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-4803
Mailing Address - Country:US
Mailing Address - Phone:432-570-3333
Mailing Address - Fax:
Practice Address - Street 1:401 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-4803
Practice Address - Country:US
Practice Address - Phone:432-570-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical