Healthcare Provider Details

I. General information

NPI: 1578104584
Provider Name (Legal Business Name): JMM ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S CLINTON ST
GRAND LEDGE MI
48837-2003
US

IV. Provider business mailing address

313 S CLINTON ST
GRAND LEDGE MI
48837-2003
US

V. Phone/Fax

Practice location:
  • Phone: 517-925-8375
  • Fax:
Mailing address:
  • Phone: 517-925-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MINDY J. PARSHALL
Title or Position: MANAGER/OWNER
Credential:
Phone: 517-285-2559