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General NPI Number Information
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NPI Number | 1609621143
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Entity Type | Organization
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Legal Business Name | DEPRESSION HEALING CLINIC
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 1200 N WEST AVE STE 800
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City | JACKSON
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State | MI
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Zip | 49202-2179
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Country | US
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Telephone | 517-998-4325
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Fax | 517-796-4561
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Provider Business Mailing Address
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Address Line | 1200 N WEST AVE STE 800
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City | JACKSON
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State | MI
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Zip | 49202-2179
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Country | US
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Telephone | 517-998-4325
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Fax | 517-796-4561
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | CASSONDRA MCGINN
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Credential | LPC
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Telephone | 734-219-9636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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