Healthcare Provider Details

I. General information

NPI: 1740571603
Provider Name (Legal Business Name): JENNIFER R PLACE MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N LAPEER ST
LAKE ORION MI
48362-3159
US

IV. Provider business mailing address

45 N LAPEER ST
LAKE ORION MI
48362-3159
US

V. Phone/Fax

Practice location:
  • Phone: 248-693-9614
  • Fax: 248-693-9615
Mailing address:
  • Phone: 248-693-9614
  • Fax: 248-693-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: