Provider Demographics
NPI:1235491879
Name:JADHAV, TRISHA L (LPC,MA)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:L
Last Name:JADHAV
Suffix:
Gender:F
Credentials:LPC,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4473 220TH AVE
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8593
Mailing Address - Country:US
Mailing Address - Phone:231-832-2247
Mailing Address - Fax:
Practice Address - Street 1:4473 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677
Practice Address - Country:US
Practice Address - Phone:231-832-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid