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General NPI Number Information
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NPI Number | 1982597878
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Entity Type | Organization
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Legal Business Name | JUPITER HEALING
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 801 S GARFIELD AVE STE 222
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3429
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Country | US
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Telephone | 231-715-1568
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Fax | 855-933-2331
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Provider Business Mailing Address
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Address Line | 5292 VOICE RD
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City | KINGSLEY
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State | MI
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Zip | 49649-9607
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Country | US
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Telephone | 231-570-0251
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | AMANDA JEAN KEARNS
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Credential | LCSW
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Telephone | 231-570-2510
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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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