Jubilee Leadership Academy
Organization Active NPI Community/Behavioral Health Agency · Prescott, WA
NPI 1477940419 · NPPES record last updated Apr 17, 2015
Key facts
- NPI
- 1477940419
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- JUBILEE LEADERSHIP ACADEMY
- Practice address
- 29 Jubilee Cir
Prescott, WA 99348-8607 - Phone
- (509) 749-2103
- NPI assigned
- Apr 16, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Kendall Todd Wagner, LICSW
- Title
- Clinical Director
- Phone
- (509) 749-2103
Practitioners 3
-
Kendall Todd Carman-Wagner, LICSW
-
Sheila Hair, LMHC
National Provider Directory
Locations
29 Jubilee Cir
Prescott, WA 99348
Phone (509) 749-2103
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
29 Jubilee Cir
Prescott, WA 99348-8607
Mailing address
29 Jubilee Cir
Prescott, WA 99348-8607
Phone (509) 749-2103
Other providers in Prescott, WA
All providers in Prescott, WA · Community/Behavioral Health Agency in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.