Healthcare Provider Details

I. General information

NPI: 1225940901
Provider Name (Legal Business Name): MRS. LATANYA D. JARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 3
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

PO BOX 224
COMSTOCK PARK MI
49321-0224
US

V. Phone/Fax

Practice location:
  • Phone: 616-366-7289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: