Healthcare Provider Details

I. General information

NPI: 1154757060
Provider Name (Legal Business Name): JILL PATRICE CHESTANG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 WHITES RD STE 4
KALAMAZOO MI
49008-2883
US

IV. Provider business mailing address

740 LYNN AVE
KALAMAZOO MI
49008-4910
US

V. Phone/Fax

Practice location:
  • Phone: 866-232-5389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018076
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018076
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: