Healthcare Provider Details

I. General information

NPI: 1144611765
Provider Name (Legal Business Name): JAMOR JAMES ACTT THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3283 122ND AVE
ALLEGAN MI
49010-9590
US

IV. Provider business mailing address

PO BOX 130
ALLEGAN MI
49010-0130
US

V. Phone/Fax

Practice location:
  • Phone: 269-673-3384
  • Fax: 269-686-5201
Mailing address:
  • Phone: 269-673-3384
  • Fax: 269-686-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117375
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: