Healthcare Provider Details

I. General information

NPI: 1275395022
Provider Name (Legal Business Name): JILLIAN RAINWATER LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 02/03/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 SLEIGHT RD
BATH MI
48808-7417
US

IV. Provider business mailing address

PO BOX 23211
LANSING MI
48909-3211
US

V. Phone/Fax

Practice location:
  • Phone: 989-600-9880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN RAINWATER
Title or Position: CEO
Credential:
Phone: 989-600-9880