Provider Demographics
NPI:1295493534
Name:AVERY, JADE LIN
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:LIN
Last Name:AVERY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 S 48TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5303
Mailing Address - Country:US
Mailing Address - Phone:520-640-7189
Mailing Address - Fax:888-900-9080
Practice Address - Street 1:8222 S 48TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5303
Practice Address - Country:US
Practice Address - Phone:520-640-7189
Practice Address - Fax:888-900-9080
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional