Provider Demographics
NPI:1306036959
Name:JENISON PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:JENISON PSYCHOLOGICAL SERVICES INC
Other - Org Name:JENISON PSYCHOLOGICAL SERVICES, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-457-0016
Mailing Address - Street 1:1836 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8901
Mailing Address - Country:US
Mailing Address - Phone:616-457-0016
Mailing Address - Fax:616-457-1950
Practice Address - Street 1:1836 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8901
Practice Address - Country:US
Practice Address - Phone:616-457-0016
Practice Address - Fax:616-457-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION96740Medicare PIN