Individual
JADE N MELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, BS
Contact information
Practice address
106 EDWARDS ST, NEWTON, IL 62448-1736
(618) 783-4154
Mailing address
106 EDWARDS ST, NEWTON, IL 62448-1736
(618) 783-4154
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376001106006
—
IL
05
—
376001106007
—
IL
Enumeration date
09/14/2020
Last updated
09/14/2020
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