Provider Demographics
NPI:1609519743
Name:DACUS, JADE ALLYN (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALLYN
Last Name:DACUS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 UPPER LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5004
Mailing Address - Country:US
Mailing Address - Phone:817-965-2825
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6800
Practice Address - Country:US
Practice Address - Phone:817-382-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional