Individual
SHADA JAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
4780 I 55 N STE 105, JACKSON, MS 39211-5542
(601) 956-4816
(601) 956-4817
Mailing address
PO BOX 1046, CLARKSDALE, MS 38614-1046
(662) 627-7267
(662) 627-5240
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01670076
—
MS
Enumeration date
09/29/2015
Last updated
03/24/2022
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