| Michigan-online Therapy Pllc | |
|
3970 Philrose Dr Jackson MI 49201-9129 | |
| (765) 543-7227 | |
| Not Available |
| Full Name | Michigan-online Therapy Pllc |
|---|---|
| Speciality | Counselor |
| Location | 3970 Philrose Dr, Jackson, Michigan |
| Authorized Official Name and Position | Jessica Van Cleave (OWNER) |
| Authorized Official Contact | 5177981527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan-online Therapy Pllc 3970 Philrose Dr Jackson MI 49201-9129 Ph: (765) 543-7227 | Michigan-online Therapy Pllc 3970 Philrose Dr Jackson MI 49201-9129 Ph: (765) 543-7227 |
| NPI Number | 1316582646 |
|---|---|
| Provider Enumeration Date | 11/11/2019 |
| Last Update Date | 03/21/2024 |
| Certification Date | 03/21/2024 |
| Medicare PECOS PAC ID | 9537501929 |
|---|---|
| Medicare Enrollment ID | O20240530003742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316582646 | NPI | - | NPPES |
| 1316582646 | Medicaid | MI | |
| 1316582646 | Other | NPI2 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jessica Van Cleave |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316364862 PECOS PAC ID: 1355783747 Enrollment ID: I20240530003781 |
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