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General NPI Number Information
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NPI Number | 1942703483
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Entity Type | Organization
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Legal Business Name | JENNIFER A PICKETT, LLC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 185 44TH ST SW STE E
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City | GRANDVILLE
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State | MI
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Zip | 49418-3363
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Country | US
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Telephone | 269-397-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 2169 124TH AVE
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City | HOPKINS
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State | MI
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Zip | 49328-9638
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Country | US
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Telephone | 269-397-0088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER ALISSA PICKETT
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Credential | MA, LPC
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Telephone | 269-397-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401013661
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License Number State | MI
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