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General NPI Number Information
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NPI Number | 1396119582
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Entity Type | Individual
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Provider Name | JASON FRANK RILEY LPC
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Gender | Male
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 6639 CENTURION DR STE 130
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City | LANSING
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State | MI
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Zip | 48917-8273
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Country | US
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Telephone | 517-322-3050
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Fax | 517-709-7701
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Provider Business Mailing Address
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Address Line | 2004 CUMBERLAND RD
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City | LANSING
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State | MI
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Zip | 48906-3718
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Country | US
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Telephone | 616-516-9059
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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 | 6401015204
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License Number State | MI
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