Healthcare Provider Details

I. General information

NPI: 1457141079
Provider Name (Legal Business Name): LJR WELLNESS CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E BROADWAY ST STE 207
MT PLEASANT MI
48858-2776
US

IV. Provider business mailing address

600 E BROADWAY ST STE 207
MT PLEASANT MI
48858-2776
US

V. Phone/Fax

Practice location:
  • Phone: 231-846-8825
  • Fax: 231-846-8825
Mailing address:
  • Phone: 231-846-8825
  • Fax: 231-846-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: LEAH JEAN RUTKOWSKI
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, NCC
Phone: 231-248-8825