Healthcare Provider Details

I. General information

NPI: 1801756879
Provider Name (Legal Business Name): JWB AUTISM SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E GRAND BLANC RD STE C
GRAND BLANC MI
48439-3310
US

IV. Provider business mailing address

360 E GRAND BLANC RD STE C
GRAND BLANC MI
48439-3310
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-4224
  • Fax: 844-918-0774
Mailing address:
  • Phone: 810-230-4224
  • Fax: 844-918-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MOLLY BARNHART
Title or Position: OWNER
Credential: LPC
Phone: 989-482-9444