Provider Demographics
NPI:1306003363
Name:RUSH, JADA I (LM CPM LMFT)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:I
Last Name:RUSH
Suffix:
Gender:F
Credentials:LM CPM LMFT
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:IAHRASHA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:202 W ORAIBI DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 W ORAIBI DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4772
Practice Address - Country:US
Practice Address - Phone:480-744-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001869A106H00000X
AZLM254176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist