Individual
MRS. JESSICA LYNN MANGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, LLP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5270
(616) 455-5460
Mailing address
12895 WOODGROVE DR, SOUTH LYON, MI 48178-8872
(269) 598-8780
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401009818
MI
101YP2500X
Professional Counselor
6401009818
MI
103T00000X
Psychologist
6361000886
MI
Other
Enumeration date
12/13/2006
Last updated
09/24/2024
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