Provider Demographics
NPI:1235738311
Name:SKIDMORE, JADE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2328 SOUTHWAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-1030
Mailing Address - Country:US
Mailing Address - Phone:830-857-3758
Mailing Address - Fax:
Practice Address - Street 1:121 W HICKORY ST STE 122
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4190
Practice Address - Country:US
Practice Address - Phone:469-860-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional