Healthcare Provider Details

I. General information

NPI: 1578138087
Provider Name (Legal Business Name): LIVING GRATEFUL BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E WASHINGTON AVE STE 180-B
JACKSON MI
49201-2393
US

IV. Provider business mailing address

209 E WASHINGTON AVE STE 180-B
JACKSON MI
49201-2393
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-7075
  • Fax: 517-518-8829
Mailing address:
  • Phone: 517-748-7075
  • Fax: 517-518-8829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MURE
Title or Position: OWNER
Credential: LMSW, CAADC
Phone: 517-748-7075