Provider Demographics
NPI:1164574430
Name:JLS COUNSELING & MENTORING LLC
Entity Type:Organization
Organization Name:JLS COUNSELING & MENTORING LLC
Other - Org Name:JLS COUNSELING & MENTORING LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ACSW BSN RN
Authorized Official - Phone:616-940-9090
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:2268 THISTLEDOWNE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6325
Practice Address - Country:US
Practice Address - Phone:616-940-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010809521041C0700X
MI4704077527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8008944510OtherBCBS
MIF=========001OtherSTATE VENDOR
8008944510OtherBCBS
MIF=========001OtherSTATE VENDOR
MION8330Medicare ID - Type Unspecified