Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | MI |
NPI | 1548889439 |
---|---|
Provider Name | Terri Lynne Jarvis |
First Address | Davison, MI 48423-7823 |
Second Address | Davison, MI 48423-7823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 10/04/2020 |