Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 39001203A | IN |
Y | 101YP2500X | Professional Counselor | 6401013226 | MI |
N | 101YS0200X | School Counselor | 176240 | MI |
NPI | 1184965410 |
---|---|
Provider Name | Ms. Jennifer Ervin |
First Address | Dowagiac, MI 49047-9766 |
Second Address | Dowagiac, MI 49047-9766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 12/03/2013 |