Provider Demographics
NPI:1265251995
Name:MCMILLAN, JADE RENEE (RADT)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:RENEE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31750 LANDAU BLVD APT A64
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5132
Mailing Address - Country:US
Mailing Address - Phone:760-235-2044
Mailing Address - Fax:
Practice Address - Street 1:13525 CIELO AZUL WAY
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240
Practice Address - Country:US
Practice Address - Phone:760-329-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1506030523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)