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NPI Code Detail

MEDICARE: JACLYNN GEORGE L.L.P.C.

MEDICARE: JACLYNN GEORGE L.L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor6401014867MI

General Provider Information

NPI Number : 1013381797
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYNN GEORGE L.L.P.C.
Provider Business Mailing Address
First Line : 3177 NEWBURY PL
Second Line :
City : TROY
State : MI
Zip : 48084-7033
Country : US
Telephone Number : 248-266-0453
Fax Number :
Provider Business Practice Location Address
First Line : 2501 ROCHESTER CT
Second Line :
City : TROY
State : MI
Zip : 48083-1875
Country : US
Telephone Number : 248-266-0453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2015
Last Update Date : 11/18/2015

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