Individual
MRS. JENNY M CLEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLCP
Contact information
Practice address
704 EMMET ST., PETOSKEY, MI 49770
(231) 347-5511
Mailing address
704 EMMET ST., PETOSKEY, MI 49770
(231) 347-5511
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401018729
MI
101YP2500X
Professional Counselor
Primary
6401018729
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/07/2017
Last updated
12/18/2020
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