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General NPI Number Information
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NPI Number | 1417377888
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Entity Type | Individual
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Provider Name | JADE ENRIQUE TYUS
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Gender | Female
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 500 FAIRWAY DR STE 102
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-1817
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Country | US
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Telephone | 888-880-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 447 SUTTER ST STE 405
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4618
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Country | US
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Telephone | 415-992-6155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | APC010613
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License Number State | GA
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