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General NPI Number Information
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NPI Number | 1306737796
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Entity Type | Organization
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Legal Business Name | MRJ COUNSELING LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 330 E BELTLINE AVE NE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1267
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Country | US
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Telephone | 231-920-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 2721 ALBERT DR SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506-4707
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Country | US
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Telephone | 231-920-3183
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE RAE ANNE JACKSON
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Credential | LMSW, PMH-C
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Telephone | 231-920-3183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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