Provider Demographics
NPI:1225385362
Name:LEIB, JENELLE KATHLYN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:KATHLYN
Last Name:LEIB
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:500 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3100
Mailing Address - Country:US
Mailing Address - Phone:989-773-0222
Mailing Address - Fax:989-772-4241
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3100
Practice Address - Country:US
Practice Address - Phone:989-773-0222
Practice Address - Fax:989-772-4241
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401011465101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor