MEDICARE: JENNIFER THOMPSON-ORSUA MFT

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	106H00000X	Marriage & Family Therapist	4101006424	MI

General Provider Information

NPI Number	:	1508910480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER THOMPSON-ORSUA MFT

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E GRAND RIVER AVE STE 103
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4958
Country	:	US
Telephone Number	:	517-648-3499
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	09/13/2020

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