Healthcare Provider Details

I. General information

NPI: 1538518790
Provider Name (Legal Business Name): JENESSA REDER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENESSA THOMPSON

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 SOUTH EUCLID AVE
BAY CITY MI
48706-3311
US

IV. Provider business mailing address

MPA GROUP NFP, LTD. 1217 SOUTH EUCLID AVE
BAY CITY MI
48706
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-9661
  • Fax: 989-667-9680
Mailing address:
  • Phone: 989-891-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: