Provider Demographics
NPI:1649739178
Name:A PLACE FOR JUST US COUNSELING
Entity Type:Organization
Organization Name:A PLACE FOR JUST US COUNSELING
Other - Org Name:SHIJUAN KELLY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-343-8458
Mailing Address - Street 1:1476 W SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3541
Mailing Address - Country:US
Mailing Address - Phone:231-343-8458
Mailing Address - Fax:
Practice Address - Street 1:1476 W SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3541
Practice Address - Country:US
Practice Address - Phone:616-537-2401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty