Healthcare Provider Details

I. General information

NPI: 1356878557
Provider Name (Legal Business Name): WILLIAM HENNESSY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 READING AVE
JONESVILLE MI
49250-1136
US

IV. Provider business mailing address

110 READING AVE
JONESVILLE MI
49250-1136
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-2333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: