Provider Demographics
NPI:1083042998
Name:DEJONG, EMILY (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DEJONG
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3921
Mailing Address - Country:US
Mailing Address - Phone:989-317-4664
Mailing Address - Fax:989-317-3418
Practice Address - Street 1:904 E PRESTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3921
Practice Address - Country:US
Practice Address - Phone:989-317-4664
Practice Address - Fax:898-317-3418
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist