Healthcare Provider Details

I. General information

NPI: 1891257036
Provider Name (Legal Business Name): JESSICA MATTHEWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 EMBASSY DRIVE SE
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

4127 EMBASSY DRIVE SE
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-264-3202
  • Fax: 616-264-3201
Mailing address:
  • Phone: 616-264-3202
  • Fax: 616-264-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MATTHEWS
Title or Position: OWNER
Credential: LLPC
Phone: 616-264-3207