Healthcare Provider Details

I. General information

NPI: 1609713031
Provider Name (Legal Business Name): PRAISING JESUS CHRIST FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-8661
US

IV. Provider business mailing address

221 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-8661
US

V. Phone/Fax

Practice location:
  • Phone: 517-604-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY PARKER JR.
Title or Position: CEO
Credential:
Phone: 517-604-5770