Provider Demographics
NPI:1376827634
Name:MAYOWSKI, JACQUELYN MARGARET (MS, LLPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MARGARET
Last Name:MAYOWSKI
Suffix:
Gender:F
Credentials:MS, LLPC
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:HOAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1303
Mailing Address - Country:US
Mailing Address - Phone:248-613-1261
Mailing Address - Fax:248-671-3446
Practice Address - Street 1:125 W LAKE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1303
Practice Address - Country:US
Practice Address - Phone:248-613-1261
Practice Address - Fax:248-671-3446
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI6401012620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst