Healthcare Provider Details

I. General information

NPI: 1629677893
Provider Name (Legal Business Name): JACKSON HEALING CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W FRANKLIN ST
JACKSON MI
49201-1674
US

IV. Provider business mailing address

PO BOX 365
JACKSON MI
49204-0365
US

V. Phone/Fax

Practice location:
  • Phone: 517-581-4710
  • Fax: 517-905-5906
Mailing address:
  • Phone: 517-581-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER STILTNER
Title or Position: OWNER, CHIEF CLINICAL DIRECTOR
Credential: MA, LPC, NCC, CTP-C
Phone: 734-726-4038