Organization
DEEPWATER COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER BLOUGH LPC (OWNER)
(734) 776-8251
Entity
Organization
Contact information
Practice address
3150 PACKARD RD, YPSILANTI, MI 48197-1994
(734) 203-0183
Mailing address
10672 NORTHWOOD HWY, ONEKAMA, MI 49675-9612
(734) 776-8251
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401014637
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528456019
PERSONAL NPI
MI
Enumeration date
03/22/2017
Last updated
01/14/2021
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