| Jackson Healing Clinic Llc | |
|
2020 Cascade Dr Jackson MI 49203-3810 | |
| (517) 867-2386 | |
| Not Available |
| Full Name | Jackson Healing Clinic Llc |
|---|---|
| Speciality | Counselor |
| Location | 2020 Cascade Dr, Jackson, Michigan |
| Authorized Official Name and Position | David Goolsby (PRESIDENT) |
| Authorized Official Contact | 5178672386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Healing Clinic Llc 2020 Cascade Dr Jackson MI 49203-3810 Ph: (517) 867-2386 | Jackson Healing Clinic Llc 2020 Cascade Dr Jackson MI 49203-3810 Ph: (517) 867-2386 |
| NPI Number | 1629677893 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 10/20/2020 |
| Certification Date | 10/20/2020 |
| Medicare PECOS PAC ID | 0840603031 |
|---|---|
| Medicare Enrollment ID | O20210107000916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629677893 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jean Concannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912446139 PECOS PAC ID: 6901181585 Enrollment ID: I20170322000615 |
| Provider Name | Joseph Uppal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154652865 PECOS PAC ID: 4183057003 Enrollment ID: I20191231001946 |
| Provider Name | Tabitha Marie Harden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073116745 PECOS PAC ID: 4183089014 Enrollment ID: I20230428001722 |
| Provider Name | Christine Frieda Gjestland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487997797 PECOS PAC ID: 9335591767 Enrollment ID: I20240122000664 |
| Provider Name | Corena Lene Herder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205439858 PECOS PAC ID: 5890148670 Enrollment ID: I20240129000909 |
| Provider Name | Valerie Walker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508241787 PECOS PAC ID: 1456704196 Enrollment ID: I20240129003603 |
| Provider Name | Lindsey Johns |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639547961 PECOS PAC ID: 0446603153 Enrollment ID: I20240130001129 |
| Provider Name | Christine Susan Delagrange |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861979320 PECOS PAC ID: 4183077746 Enrollment ID: I20240130003222 |
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