Provider Demographics
NPI:1669943551
Name:MITCHELL, JADE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4307 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-3122
Mailing Address - Country:US
Mailing Address - Phone:502-592-5389
Mailing Address - Fax:
Practice Address - Street 1:4307 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-3122
Practice Address - Country:US
Practice Address - Phone:502-592-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2536771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical