Provider Demographics
NPI:1316391097
Name:DEPUE, JADE RACHAEL (LPC)
Entity Type:Individual
Prefix:MS
First Name:JADE
Middle Name:RACHAEL
Last Name:DEPUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101
Mailing Address - Country:US
Mailing Address - Phone:573-634-3432
Mailing Address - Fax:636-898-0951
Practice Address - Street 1:925 MADISON STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101
Practice Address - Country:US
Practice Address - Phone:573-634-3432
Practice Address - Fax:636-898-0951
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016011184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490031448Medicaid