Healthcare Provider Details

I. General information

NPI: 1306957444
Provider Name (Legal Business Name): JACKSON BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E WASHINGTON AVE SUITE 221
JACKSON MI
49201-2393
US

IV. Provider business mailing address

209 E WASHINGTON AVE SUITE 221
JACKSON MI
49201-2393
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-0809
  • Fax: 517-788-5922
Mailing address:
  • Phone: 517-780-0809
  • Fax: 517-788-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301010119
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6302006268
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number4301044183
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4301044183
License Number StateMI

VIII. Authorized Official

Name: MR. BRADLEY L SCHWEDA
Title or Position: PSYCHOLOGIST
Credential: LLP
Phone: 517-780-0809