Healthcare Provider Details

I. General information

NPI: 1679335897
Provider Name (Legal Business Name): MORGAN JENNA TERBOVICH MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 NORTHLAND DR NE
GRAND RAPIDS MI
49525-1096
US

IV. Provider business mailing address

7320 WILKINSON DR NE
ROCKFORD MI
49341-8694
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-5001
  • Fax:
Mailing address:
  • Phone: 614-348-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: