Healthcare Provider Details

I. General information

NPI: 1265017917
Provider Name (Legal Business Name): WANDERING PATH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 JOCHAR RD
CLAY MI
48001-3021
US

IV. Provider business mailing address

7332 JOCHAR RD
CLAY MI
48001-3021
US

V. Phone/Fax

Practice location:
  • Phone: 313-574-9296
  • Fax:
Mailing address:
  • Phone: 586-500-8080
  • Fax: 586-500-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER J GEE
Title or Position: OWNER
Credential: LMSW
Phone: 313-574-9296