Provider Demographics
NPI:1326829631
Name:JENNIFER GAUVIN LLC
Entity Type:Organization
Organization Name:JENNIFER GAUVIN LLC
Other - Org Name:HEALING CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:GAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-719-4498
Mailing Address - Street 1:21456 SUMMERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1026
Mailing Address - Country:US
Mailing Address - Phone:586-719-4498
Mailing Address - Fax:
Practice Address - Street 1:164 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1236
Practice Address - Country:US
Practice Address - Phone:734-335-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health