Provider Demographics
NPI:1487223715
Name:ARCHULETA, JAYDE LAREE
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:LAREE
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 N SHEFFIELD AVE UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1714
Mailing Address - Country:US
Mailing Address - Phone:801-891-2366
Mailing Address - Fax:
Practice Address - Street 1:3525 N SHEFFIELD AVE UNIT G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1714
Practice Address - Country:US
Practice Address - Phone:801-891-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health