Provider Demographics
NPI:1871966275
Name:DECKERT, JENNIFER (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:DECKERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WASHINGTON AVE STE 367
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1378
Mailing Address - Country:US
Mailing Address - Phone:616-349-6551
Mailing Address - Fax:616-935-1288
Practice Address - Street 1:41 WASHINGTON AVE STE 367
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1378
Practice Address - Country:US
Practice Address - Phone:616-405-4733
Practice Address - Fax:616-935-1288
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487902003OtherTYPE 2 NPI