Healthcare Provider Details

I. General information

NPI: 1396325437
Provider Name (Legal Business Name): JAYMIE TIBBITS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6825
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6825
US

V. Phone/Fax

Practice location:
  • Phone: 517-237-7350
  • Fax:
Mailing address:
  • Phone: 517-237-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119464
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: