Organization
MICHIGAN-ONLINE THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA VAN CLEAVE LPC (OWNER)
(517) 798-1527
Entity
Organization
Contact information
Practice address
3970 PHILROSE DR, JACKSON, MI 49201-9129
(765) 543-7227
Mailing address
3970 PHILROSE DR, JACKSON, MI 49201-9129
(765) 543-7227
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316582646
NPI2
—
05
—
1316582646
—
MI
Enumeration date
11/11/2019
Last updated
03/21/2024
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