MEDICARE: JESSICA A. TOPOR, LLC

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1912566548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA A. TOPOR, LLC

Provider Business Mailing Address
First Line	:	28592 ORCHARD LAKE RD STE 301
Second Line	:
City	:	FARMINGTN HLS
State	:	MI
Zip	:	48334-2903
Country	:	US
Telephone Number	:	248-535-5206
Fax Number	:

Provider Business Practice Location Address
First Line	:	25600 WOODWARD AVE STE 215
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-0945
Country	:	US
Telephone Number	:	248-399-7447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA TOPOR
Credential	:	LMFT
Telephone Number	:	248-535-5206

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	06/07/2019

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