Provider Demographics
NPI:1932667532
Name:GERAGHTY, JADE J (BS, CMII)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:J
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:BS, CMII
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:J
Other - Last Name:GERAGHTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NOEMI JADE GERAGHTY
Mailing Address - Street 1:602 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6912
Mailing Address - Country:US
Mailing Address - Phone:580-470-6391
Mailing Address - Fax:
Practice Address - Street 1:602 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6912
Practice Address - Country:US
Practice Address - Phone:580-470-6391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty