Healthcare Provider Details

I. General information

NPI: 1679732853
Provider Name (Legal Business Name): JEFFREY ALLEN SENK LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

IV. Provider business mailing address

N9937 EAST SHORE ROAD PO BOX 137
MARENISCO MI
49947
US

V. Phone/Fax

Practice location:
  • Phone: 906-229-6120
  • Fax: 906-229-6191
Mailing address:
  • Phone: 906-229-6135
  • Fax: 906-229-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number200897
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801090229
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: