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General NPI Number Information
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NPI Number | 1245895598
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Entity Type | Organization
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Legal Business Name | JADEA CORP
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 10935 ESTATE LN STE 205
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City | DALLAS
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State | TX
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Zip | 75238-5173
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Country | US
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Telephone | 214-205-0672
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Fax |
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Provider Business Mailing Address
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Address Line | 250 ACR 2912
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City | PALESTINE
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State | TX
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Zip | 75803
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Country | US
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Telephone | 903-724-0958
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JEWELL LAVERN SAWYER
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Credential |
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Telephone | 903-724-0958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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