Healthcare Provider Details

I. General information

NPI: 1609320324
Provider Name (Legal Business Name): JADE EYLER MA,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRING ST STE 215
SHREVEPORT LA
71101
US

IV. Provider business mailing address

1421 LYNCHBURG CIR BLDG N
BOSSIER CITY LA
71112-3557
US

V. Phone/Fax

Practice location:
  • Phone: 318-227-8390
  • Fax:
Mailing address:
  • Phone: 808-754-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6838
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: