Healthcare Provider Details

I. General information

NPI: 1013674407
Provider Name (Legal Business Name): ESSENCE JACKSON-JONES MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 DUDLEY AVE
MUSKEGON MI
49442-2204
US

IV. Provider business mailing address

1411 DUDLEY AVE
MUSKEGON MI
49442-2204
US

V. Phone/Fax

Practice location:
  • Phone: 773-403-7605
  • Fax:
Mailing address:
  • Phone: 773-403-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180014133
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87854
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: