Provider Demographics
NPI:1184387391
Name:WHITE, JADA KENNICE (PLMHP)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:KENNICE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 S 70TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 S COSTELLO STREET
Practice Address - Street 2:
Practice Address - City:WALTHILL
Practice Address - State:NE
Practice Address - Zip Code:68067
Practice Address - Country:US
Practice Address - Phone:402-846-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health