MEDICARE: JADE HOLLAN

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	101YM0800X	Mental Health Counselor		KY
2	103TC1900X	Counseling Psychologist	285440	KY
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1871037507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE HOLLAN

Provider Business Mailing Address
First Line	:	501 DARBY CREEK RD STE 41
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 DARBY CREEK RD STE 41
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1671
Country	:	US
Telephone Number	:	859-785-1882
Fax Number	:

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

Provider Enumeration Date	:	12/14/2016
Last Update Date	:	06/28/2024

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Directions to “ JADE HOLLAN ” Practice Location

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