Provider Demographics
NPI:1083388128
Name:JENELLE K. LEIB, MA LPC, PLLC
Entity Type:Organization
Organization Name:JENELLE K. LEIB, MA LPC, PLLC
Other - Org Name:GREEN LOTUS PROFESSIONAL COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:JENELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEIB
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:989-572-0004
Mailing Address - Street 1:306 E BROADWAY ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2659
Mailing Address - Country:US
Mailing Address - Phone:989-572-0004
Mailing Address - Fax:989-702-2266
Practice Address - Street 1:306 E BROADWAY ST STE 4A
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2659
Practice Address - Country:US
Practice Address - Phone:989-572-0004
Practice Address - Fax:989-702-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty