Healthcare Provider Details

I. General information

NPI: 1083405617
Provider Name (Legal Business Name): JENEE WILSON MS, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HASLETT RD STE 101
EAST LANSING MI
48823-2823
US

IV. Provider business mailing address

411 JACKSON ST
GRAND LEDGE MI
48837-1703
US

V. Phone/Fax

Practice location:
  • Phone: 517-231-0297
  • Fax:
Mailing address:
  • Phone: 517-231-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: