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NPI Code Detail

MEDICARE: JESSICA PREVOST

MEDICARE: JESSICA PREVOST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1366900813
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PREVOST
Provider Business Mailing Address
First Line : 8285 S SAGINAW ST STE 102
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-2436
Country : US
Telephone Number : 482-633-6538
Fax Number :
Provider Business Practice Location Address
First Line : 6672 NEWARK RD
Second Line :
City : IMLAY CITY
State : MI
Zip : 48444-9657
Country : US
Telephone Number : 248-633-6538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2019
Last Update Date : 04/04/2024

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Directions to “ JESSICA PREVOST ” Practice Location

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