Healthcare Provider Details

I. General information

NPI: 1356810030
Provider Name (Legal Business Name): JESSICA BILLUPS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2018
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37450 SCHOOLCRAFT RD
LIVONIA MI
48150-1082
US

IV. Provider business mailing address

37450 SCHOOLCRAFT RD
LIVONIA MI
48150-1082
US

V. Phone/Fax

Practice location:
  • Phone: 734-744-0170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801102788
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801103788
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: