Individual
JESSICA JOYCE MAYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1125 E MILHAM AVE STE B, PORTAGE, MI 49002-3096
(269) 312-1446
(269) 775-1079
Mailing address
38785 WINGATE DR, CLINTON TOWNSHIP, MI 48038-3248
(586) 489-9121
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401013204
MI
101YP2500X
Professional Counselor
Primary
6401013204
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YM0800X
—
MI
05
—
1396099628
—
MI
Enumeration date
11/08/2012
Last updated
06/12/2023
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