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General NPI Number Information
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NPI Number | 1972466753
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Entity Type | Organization
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Legal Business Name | ADDIJACKLLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 145 CHAPARRAL EST
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City | SHADY SHORES
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State | TX
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Zip | 76208-5735
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Country | US
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Telephone | 940-595-3778
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Fax |
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Provider Business Mailing Address
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Address Line | 145 CHAPARRAL EST
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City | SHADY SHORES
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State | TX
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Zip | 76208-5735
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Country | US
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Telephone | 940-595-3778
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Fax |
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Authorized Official
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Title or Position | OWNER AND THERAPIST
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Name | MICHELE MENZIE
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Credential | LCSW-S
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Telephone | 940-595-3778
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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 |
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License Number State |
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