Provider Demographics
NPI:1134900038
Name:JADE, LLC
Entity type:Organization
Organization Name:JADE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE ALEXA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-719-7847
Mailing Address - Street 1:609 W REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2427
Mailing Address - Country:US
Mailing Address - Phone:479-719-7847
Mailing Address - Fax:
Practice Address - Street 1:609 W REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2427
Practice Address - Country:US
Practice Address - Phone:479-719-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare