Healthcare Provider Details

I. General information

NPI: 1063379337
Provider Name (Legal Business Name): JENNIFER THERESA HOOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 W ST JOE HWY STE 205
LANSING MI
48917-4850
US

IV. Provider business mailing address

8049 CORRISON RD
GRAND LEDGE MI
48837-9252
US

V. Phone/Fax

Practice location:
  • Phone: 517-626-9294
  • Fax:
Mailing address:
  • Phone: 517-626-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451007361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: