Individual
JESSICA BEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
8623 N WAYNE RD, WESTLAND, MI 48185-1137
(734) 425-0636
Mailing address
19317 ANTAGO ST, LIVONIA, MI 48152-2511
(313) 289-2960
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401014535
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326418021
—
MI
Enumeration date
10/07/2015
Last updated
04/18/2018
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