Organization
MIND BODY & SOUL CONNECTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE SHPAK LLP (PSYCHOLOGIST MASTERS LEVEL)
(734) 674-2515
Entity
Organization
Contact information
Practice address
13185 WACOUSTA RD, GRAND LEDGE, MI 48837-9254
(734) 674-2515
Mailing address
13185 WACOUSTA RD, GRAND LEDGE, MI 48837-9254
(734) 674-2515
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/08/2020
Last updated
04/22/2026
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