Healthcare Provider Details

I. General information

NPI: 1730979402
Provider Name (Legal Business Name): JADA LEWIS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 WHEELER RD
WHITE PINE TN
37890-4232
US

IV. Provider business mailing address

912 WHEELER RD
WHITE PINE TN
37890-4232
US

V. Phone/Fax

Practice location:
  • Phone: 865-387-2420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2499
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: