Provider Demographics
NPI:1417844754
Name:BADGETT, JASON SHANE (AA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SHANE
Last Name:BADGETT
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N COUNTRY CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1650
Mailing Address - Country:US
Mailing Address - Phone:520-229-6220
Mailing Address - Fax:
Practice Address - Street 1:3131 N COUNTRY CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1650
Practice Address - Country:US
Practice Address - Phone:520-229-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health