Healthcare Provider Details

I. General information

NPI: 1073147591
Provider Name (Legal Business Name): JENNIFER SEIM-ANDREW LICENSED PROFESSIONAL COUNSELOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 W ANN ARBOR TRL STE 106
PLYMOUTH MI
48170-6262
US

IV. Provider business mailing address

9929 CAVELL ST
LIVONIA MI
48150-3221
US

V. Phone/Fax

Practice location:
  • Phone: 734-502-9222
  • Fax:
Mailing address:
  • Phone: 734-502-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SEIM-ANDREW
Title or Position: COUNSELOR
Credential:
Phone: 734-502-9222