Healthcare Provider Details

I. General information

NPI: 1508910480
Provider Name (Legal Business Name): JENNIFER THOMPSON-ORSUA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 COMMONS PKWY
OKEMOS MI
48864-3988
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-648-3499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: