Healthcare Provider Details

I. General information

NPI: 1992228811
Provider Name (Legal Business Name): JESSICA DAWN ALLISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 07/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 W WILLOW HWY
LANSING MI
48917-1231
US

IV. Provider business mailing address

6211 W WILLOW HWY
LANSING MI
48917-1231
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-5055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: