MEDICARE: JADA HENDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT002337	GA
2	106S00000X	Behavior Technician
3	106H00000X	Marriage & Family Therapist	L325	AL

General Provider Information

NPI Number	:	1831654342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA HENDERSON

Provider Business Mailing Address
First Line	:	2022 15TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1699
Country	:	US
Telephone Number	:	706-649-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 13TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2246
Country	:	US
Telephone Number	:	706-780-1704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2019
Last Update Date	:	06/16/2026

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Directions to “ JADA HENDERSON ” Practice Location

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