Healthcare Provider Details

I. General information

NPI: 1679516686
Provider Name (Legal Business Name): JAYNA LEE PYKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYNA LEE JOHNSON LPC

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOUTH BLVD W STE 200
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-6234
  • Fax: 248-844-6237
Mailing address:
  • Phone: 586-753-0405
  • Fax: 586-753-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009520
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: