1255844221 NPI number — MS. JENNIFER L TREMONTI MA, LLPC, SCL

Table of content: MS. JENNIFER L TREMONTI MA, LLPC, SCL (NPI 1255844221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255844221 NPI number — MS. JENNIFER L TREMONTI MA, LLPC, SCL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREMONTI
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LLPC, SCL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADKINS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255844221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6549 TOWN CENTER DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346-4824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-620-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23332 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-451-3271
Provider Business Practice Location Address Fax Number:
313-451-3271
Provider Enumeration Date:
11/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401016294 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)