Provider Demographics
NPI:1598980039
Name:SALAMINO, JODI LEE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LEE
Last Name:SALAMINO
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 LAKE ANN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ANN
Mailing Address - State:MI
Mailing Address - Zip Code:49650-9730
Mailing Address - Country:US
Mailing Address - Phone:231-275-3859
Mailing Address - Fax:
Practice Address - Street 1:236 1 2 EAST FRONT STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-631-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI117680253046Medicare UPIN