MEDICARE: JASON FRANK RILEY LPC

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
1	101YM0800X	Mental Health Counselor	6401015204	MI

General Provider Information

NPI Number	:	1396119582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON FRANK RILEY LPC

Provider Business Mailing Address
First Line	:	2004 CUMBERLAND RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48906-3718
Country	:	US
Telephone Number	:	616-516-9059
Fax Number	:

Provider Business Practice Location Address
First Line	:	6639 CENTURION DR STE 130
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8273
Country	:	US
Telephone Number	:	517-322-3050
Fax Number	:	517-709-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	01/15/2021

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