Healthcare Provider Details

I. General information

NPI: 1750750683
Provider Name (Legal Business Name): JENNA WHITEFOOT M.A., L.P.C., N.C.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA WHITEFOOT

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10831 S WOODFIELD CIR
BRIGHTON MI
48114-9292
US

IV. Provider business mailing address

10831 S WOODFIELD CIR
BRIGHTON MI
48114-9292
US

V. Phone/Fax

Practice location:
  • Phone: 734-765-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax: 734-436-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401014880
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401014880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: