Individual
MR. JALEN KAINICK BOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A, LPC
Contact information
Practice address
1200 N WEST AVE, JACKSON, MI 49202-2179
(517) 789-1209
Mailing address
2755 GRANADA DR APT 1C, JACKSON, MI 49202-5257
(269) 578-6389
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401019007
MI
101Y00000X
Counselor
Primary
6401223573
MI
101Y00000X
Counselor
—
—
Other
Enumeration date
01/25/2021
Last updated
10/28/2024
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