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1200 N. West Avenue Jackson MI 49202 | |
| (517) 789-1209 | |
| (517) 796-4532 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 N. West Avenue, Jackson, Michigan |
| Authorized Official Name and Position | Maribeth J Leonard (CHIEF EXECUTIVE OFFICER (CEO)) |
| Authorized Official Contact | 5177891208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1200 N. West Avenue Jackson MI 49202 Ph: (517) 789-1209 | 1200 N. West Avenue Jackson MI 49202 Ph: (517) 789-1209 |
| NPI Number | 1063466274 |
|---|---|
| Provider Enumeration Date | 05/20/2006 |
| Last Update Date | 09/19/2024 |
| Certification Date | 09/19/2024 |
| Medicare PECOS PAC ID | 6406808062 |
|---|---|
| Medicare Enrollment ID | O20050211000601 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063466274 | NPI | - | NPPES |
| 1712229 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Manish Prasad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558395947 PECOS PAC ID: 8325096340 Enrollment ID: I20050106000592 |
| Provider Name | Zakia I Alavi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154474617 PECOS PAC ID: 2567411820 Enrollment ID: I20050114000209 |
| Provider Name | Christina I Zachar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265534804 PECOS PAC ID: 8022060318 Enrollment ID: I20050215000517 |
| Provider Name | Penny E Jansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922122845 PECOS PAC ID: 2365547197 Enrollment ID: I20070424000324 |
| Provider Name | Charleitte Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972843126 PECOS PAC ID: 4284850025 Enrollment ID: I20140730002714 |
| Provider Name | Jennifer Robin Lee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730390089 PECOS PAC ID: 4082701735 Enrollment ID: I20160816000232 |
| Provider Name | Paul S Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790862225 PECOS PAC ID: 9638203789 Enrollment ID: I20171101001953 |
| Provider Name | Joseph C Drumm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619262680 PECOS PAC ID: 6305145020 Enrollment ID: I20180427000972 |
| Provider Name | Jessica Hendricks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417371501 PECOS PAC ID: 1759713266 Enrollment ID: I20191120003069 |
| Provider Name | Thomas R Best |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750540068 PECOS PAC ID: 6800920075 Enrollment ID: I20191213000404 |
| Provider Name | Lily S. Chung |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508963273 PECOS PAC ID: 7618943093 Enrollment ID: I20200507000249 |
| Provider Name | Jessica Erin Gibbons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548754898 PECOS PAC ID: 4587082391 Enrollment ID: I20200910002467 |
| Provider Name | Nathan Horton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184288433 PECOS PAC ID: 7214349729 Enrollment ID: I20201207001663 |
| Provider Name | Rebecca Reska |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679104418 PECOS PAC ID: 0143629436 Enrollment ID: I20210518001702 |
| Provider Name | Amy Kathleen Cosgrove-evens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043862527 PECOS PAC ID: 5496133175 Enrollment ID: I20220608002431 |
| Provider Name | Matthew Soden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013258631 PECOS PAC ID: 0941595607 Enrollment ID: I20220621001026 |
| Provider Name | Jessica Tucelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235797846 PECOS PAC ID: 3577943091 Enrollment ID: I20220630000626 |
| Provider Name | Adam J Colden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982251724 PECOS PAC ID: 0648645788 Enrollment ID: I20230404000130 |
| Provider Name | Ted Nicholas Jansen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629191523 PECOS PAC ID: 0648376947 Enrollment ID: I20240110000773 |
| Provider Name | Diana Allen Welsh |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710631692 PECOS PAC ID: 0143672501 Enrollment ID: I20240122001922 |
| Provider Name | Laura Susan Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669970810 PECOS PAC ID: 6002254679 Enrollment ID: I20240402000423 |
| Provider Name | Kendra Keranen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558737478 PECOS PAC ID: 6305284498 Enrollment ID: I20240409002517 |
| Provider Name | Jalen Kainick Bogan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043800956 PECOS PAC ID: 9537508353 Enrollment ID: I20240412002401 |
| Provider Name | Taylor Lynn Owens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275202673 PECOS PAC ID: 3577902162 Enrollment ID: I20240416000904 |
| Provider Name | Chinyere Sampson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104295773 PECOS PAC ID: 1557700879 Enrollment ID: I20240419001513 |
| Provider Name | Chris Jean Apostoleris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033602701 PECOS PAC ID: 5294174496 Enrollment ID: I20240422000648 |
| Provider Name | Lisa Staab |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396299442 PECOS PAC ID: 7012282023 Enrollment ID: I20240422002384 |
| Provider Name | Aaron Friese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972173466 PECOS PAC ID: 9234578378 Enrollment ID: I20240422002566 |
| Provider Name | Emily Michelle Morrison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518381623 PECOS PAC ID: 3173963147 Enrollment ID: I20240425000320 |
| Provider Name | Kelly Sigler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831417344 PECOS PAC ID: 5597105619 Enrollment ID: I20240506003504 |
| Provider Name | Taylor Wells |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598345217 PECOS PAC ID: 8325489412 Enrollment ID: I20240507001700 |
| Provider Name | Katelynn Renee Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124535489 PECOS PAC ID: 2264873348 Enrollment ID: I20240508000607 |
| Provider Name | Andrea Bricker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548684517 PECOS PAC ID: 6002054277 Enrollment ID: I20240510001436 |
| Provider Name | Shirley Jo Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780828699 PECOS PAC ID: 7719328145 Enrollment ID: I20240515003638 |
| Provider Name | Alfred Delos Santos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982168639 PECOS PAC ID: 7911349626 Enrollment ID: I20240528000702 |
| Provider Name | Promise E Haynes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912328378 PECOS PAC ID: 0042548182 Enrollment ID: I20240613001914 |
| Provider Name | Sarah Ann Mcdevitt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316252323 PECOS PAC ID: 0042753287 Enrollment ID: I20240617002086 |
| Provider Name | Emily Youtsey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578194502 PECOS PAC ID: 8426591439 Enrollment ID: I20240619000382 |
| Provider Name | Michelle Angela Norris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386903425 PECOS PAC ID: 0547678021 Enrollment ID: I20240625000990 |
| Provider Name | Randall Edward Surque |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447726146 PECOS PAC ID: 6305380445 Enrollment ID: I20240701002120 |
| Provider Name | Briana Christine Kast |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154909646 PECOS PAC ID: 4587108352 Enrollment ID: I20240703002220 |
| Provider Name | Jessica Lynn Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639823560 PECOS PAC ID: 4688108665 Enrollment ID: I20241113003029 |
| Provider Name | Lisa Schultz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043690753 PECOS PAC ID: 5193259075 Enrollment ID: I20241114002758 |
| Provider Name | Jessica E Foust |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629737739 PECOS PAC ID: 3870028301 Enrollment ID: I20241121000597 |
Alexis Ahlbaum Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5633 Poplar Dr, Jackson, MI 49201 Phone: 517-270-1994 | |
Inner Guidance Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 608 W Michigan Ave, Jackson, MI 49201 Phone: 517-416-8878 Fax: 517-962-5316 | |
Center For Family Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 N Jackson St, Jackson, MI 49201 Phone: 517-748-5500 | |
Highfields Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1206 Clinton Rd, Jackson, MI 49202 Phone: 517-783-4250 |