Provider Demographics
NPI:1043947815
Name:GOGARN, JAYD (LLPC)
Entity type:Individual
Prefix:
First Name:JAYD
Middle Name:
Last Name:GOGARN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 DORNET DR APT 427
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2633
Mailing Address - Country:US
Mailing Address - Phone:517-944-0145
Mailing Address - Fax:
Practice Address - Street 1:2450 DELHI COMMERCE DR STE 4
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2193
Practice Address - Country:US
Practice Address - Phone:517-480-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor