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General NPI Number Information
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NPI Number | 1629677893
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Entity Type | Organization
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Legal Business Name | JACKSON HEALING CLINIC LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 720 W FRANKLIN ST
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City | JACKSON
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State | MI
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Zip | 49201-1674
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Country | US
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Telephone | 517-581-4710
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Fax | 517-905-5906
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | JACKSON
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State | MI
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Zip | 49204-0365
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Country | US
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Telephone | 517-581-4710
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Fax |
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Authorized Official
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Title or Position | OWNER, CHIEF CLINICAL DIRECTOR
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Name | HEATHER STILTNER
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Credential | MA, LPC, NCC, CTP-C
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Telephone | 734-726-4038
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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 |
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License Number State |
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