Healthcare Provider Details

I. General information

NPI: 1629918412
Provider Name (Legal Business Name): JLK THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W WASHINGTON ST STE 405
MARQUETTE MI
49855-4347
US

IV. Provider business mailing address

220 W WASHINGTON ST STE 405
MARQUETTE MI
49855-4347
US

V. Phone/Fax

Practice location:
  • Phone: 906-251-1661
  • Fax:
Mailing address:
  • Phone: 906-251-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE LAINE KOSTICH-CONNORS
Title or Position: OWNER
Credential: LPC
Phone: 906-251-1661