Healthcare Provider Details

I. General information

NPI: 1225944226
Provider Name (Legal Business Name): JENNIFER MILLBAUER LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-6322
US

IV. Provider business mailing address

2088 THORBURN ST
HOLT MI
48842-1828
US

V. Phone/Fax

Practice location:
  • Phone: 517-258-0026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: