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General NPI Number Information
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NPI Number | 1346923067
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Entity Type | Individual
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Provider Name | JEANNINE MARTHEN MA, LPC, SCL
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Gender | Female
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 43329 SCHOENHERR RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-1959
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Country | US
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Telephone | 248-600-5178
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Fax |
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Provider Business Mailing Address
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Address Line | 13820 HEARTHSTONE LN
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City | HARTLAND
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State | MI
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Zip | 48353-3145
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Country | US
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Telephone | 248-505-7822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401222688
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License Number State | MI
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