MEDICARE: JADE'S COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245020858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JADE'S COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	2145 W HILL ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1923
Country	:	US
Telephone Number	:	502-718-0559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 W HILL ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1923
Country	:	US
Telephone Number	:	502-718-0559
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	STACY SOWELL
Credential	:	LPCC
Telephone Number	:	502-718-0559

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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