Provider Demographics
NPI:1134486293
Name:FLOWERS, JADE (IMFT)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:ROTHACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMFT
Mailing Address - Street 1:349 E COOKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2801
Mailing Address - Country:US
Mailing Address - Phone:614-284-2808
Mailing Address - Fax:
Practice Address - Street 1:3242 HENDERSON RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2307
Practice Address - Country:US
Practice Address - Phone:614-284-2808
Practice Address - Fax:614-999-1306
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM1300023106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291249Medicaid