Provider Demographics
NPI:1366818825
Name:SPENCE, JEREMY (LLPC, LPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:SPENCE
Suffix:
Gender:M
Credentials:LLPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2713
Mailing Address - Country:US
Mailing Address - Phone:231-313-9998
Mailing Address - Fax:231-714-4231
Practice Address - Street 1:244 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2546
Practice Address - Country:US
Practice Address - Phone:231-313-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3915805101YM0800X
OHC1200119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional