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General NPI Number Information
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NPI Number | 1578188009
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Entity Type | Individual
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Provider Name | JADE SYMONE BRANCH LPC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 3909 WOODLEY RD
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City | TOLEDO
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State | OH
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Zip | 43606-1169
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Country | US
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Telephone | 419-475-4449
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Fax |
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Provider Business Mailing Address
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Address Line | 3909 WOODLEY RD
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City | TOLEDO
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State | OH
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Zip | 43606-1169
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Country | US
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Telephone | 419-973-5531
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CT.1902139-TRNE
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2103263
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License Number State | OH
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