Provider Demographics
NPI:1073248753
Name:MCELDOWNEY, JODIE ADAMS (LLC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ADAMS
Last Name:MCELDOWNEY
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11684 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9618
Mailing Address - Country:US
Mailing Address - Phone:517-795-4483
Mailing Address - Fax:
Practice Address - Street 1:126 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3558
Practice Address - Country:US
Practice Address - Phone:734-219-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6451022307Medicaid