Healthcare Provider Details

I. General information

NPI: 1275454985
Provider Name (Legal Business Name): JKE COUNSELING AND PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MAPLE DR
VIDALIA GA
30474-8909
US

IV. Provider business mailing address

308 MAPLE DR
VIDALIA GA
30474-8909
US

V. Phone/Fax

Practice location:
  • Phone: 912-253-8003
  • Fax: 478-845-0906
Mailing address:
  • Phone: 912-253-8003
  • Fax: 478-845-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA KYLE ELLIS
Title or Position: CEO/OWNER
Credential: MS, LPC, NCC
Phone: 912-253-8003