Provider Demographics
NPI:1710674601
Name:JADA WELLNESS & PSYCHOTHERAPY
Entity Type:Organization
Organization Name:JADA WELLNESS & PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RONYAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:440-346-1888
Mailing Address - Street 1:2900 E OAKLAND PARK BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1804
Mailing Address - Country:US
Mailing Address - Phone:440-346-1888
Mailing Address - Fax:
Practice Address - Street 1:2900 E OAKLAND PARK BLVD FL 3
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1804
Practice Address - Country:US
Practice Address - Phone:440-346-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty