MRS. JADA MATLOCK (NPI# 1457865743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457865743 |
| Entity Type | Individual |
| Full Name | MRS. JADA MATLOCK |
| Practice Address |
209 W Jefferson Ave Bastrop LA 71220-4543 |
| Practice Telephone | 3182393890 |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2017-11-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
209 W JEFFERSON AVE |
| City | BASTROP |
| State | LA |
| Zip Code | 71220-4543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720351109 | Tyesha Turner | Counselor | 209 W Jefferson Ave, 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2012-02-16 |
| 1427696558 | Katina Renea Washington | Case Manager/Care Coordinator | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2019-12-19 |
| 1063075273 | Shelia Edwards | Case Manager/Care Coordinator | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2019-04-15 |
| 1629533542 | Tikela Nawana Mansfield | Case Manager/Care Coordinator | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2019-02-05 |
| 1154897007 | Shelia Brown Washington | Case Manager/Care Coordinator | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2018-10-18 |
| 1164920575 | Jeffery Turner | Counselor | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2018-01-31 |
| 1609381037 | Alisha Love | Counselor | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2017-12-07 |
| 1396255923 | Ijnanya Davis | Counselor | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2017-10-10 |
| 1477072650 | Ed Lamar Anderson | Counselor | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2017-09-19 |
| 1922525823 | Arnor Gregory Ford | Counselor | 209 W Jefferson Ave, Bastrop, LA 71220-4543 | 2017-08-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952935983 | Broken Wings Recovery Center, LLC | Substance Abuse Rehabilitation Facility | 2869 New Monroe Road, Bastrop, LA 71220 | 2020-02-28 |
| 1275002685 | Hulin Urgent Care Services, LLC | Clinic/Center | 2100 East Madison Avenue, Bastrop, LA 71220 | 2018-11-14 |
| 1023594975 | Shuntel Ramona Johnson | Counselor | 8891 Holley Farm Road, Bastrop, LA 71220 | 2018-07-13 |
| 1376050526 | Kevin Hubbard | Case Manager/Care Coordinator | 9409 Willow Dr, Bastrop, LA 71220 | 2018-01-09 |
| 1265957229 | Alma Holmes | Behavioral Analyst | 644 E. Jefferson Ave, Bastrop, LA 71220 | 2017-08-10 |
| 1427570886 | Jennifer Rochelle Glosson | Counselor | 410 S. Franklin St, Bastrop, LA 71220 | 2017-07-07 |
| 1386179307 | Total Divine Care LLC | Community/Behavioral Health | 1840 North Washington Street, Bastrop, LA 71220 | 2017-04-27 |
| 1538609524 | Tyrra Watkins | Counselor | 10599 Parkwood Dr, Bastrop, LA 71220 | 2017-02-24 |
| 1528502119 | Oatie Brooks | Counselor | 813 Mccreight Street, Bastrop, LA 71220 | 2016-12-15 |
| 1487197810 | Valencia Reese | Counselor | 10434 Boswell St, Bastrop, LA 71220 | 2016-12-03 |
| Find all providers in zip 71220 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023594975 | Shuntel Ramona Johnson | Counselor | 8891 Holley Farm Road, Bastrop, LA 71220 | 2018-07-13 |
| 1598259921 | Antionette Armetis Massey | Counselor | 9382 Syble Dr, Bastrop, LA 71220-4884 | 2018-06-19 |
| 1427570886 | Jennifer Rochelle Glosson | Counselor | 410 S. Franklin St, Bastrop, LA 71220 | 2017-07-07 |
| 1528502119 | Oatie Brooks | Counselor | 813 Mccreight Street, Bastrop, LA 71220 | 2016-12-15 |
| 1972047033 | Raven Danielle Harper | Counselor | 9414 Pridgeon St, Bastrop, LA 71220-5971 | 2016-12-08 |
| 1487197810 | Valencia Reese | Counselor | 10434 Boswell St, Bastrop, LA 71220 | 2016-12-03 |
| 1770035032 | Kia Rhodes | Counselor | 600 Oliver Ave, Bastrop, LA 71220-4916 | 2016-11-02 |
| 1467807800 | Alexis Myles | Counselor | 4574 Cedar Dr, Bastrop, LA 71220-4802 | 2016-05-03 |
| 1578920245 | Terrance Arnold | Counselor | 410 S Franklin Street, Bastrop, LA 71220 | 2016-01-26 |
| 1982069530 | Alexander Washington | Counselor | 200 West Jefferson Ave., Bastrop, LA 71221 | 2015-12-28 |
| Find all providers in BASTROP | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.