Provider Demographics
NPI:1689331100
Name:JT HERBERT CONSULTING
Entity Type:Organization
Organization Name:JT HERBERT CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:734-391-9968
Mailing Address - Street 1:13826 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-7001
Mailing Address - Country:US
Mailing Address - Phone:734-391-9968
Mailing Address - Fax:
Practice Address - Street 1:43494 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5052
Practice Address - Country:US
Practice Address - Phone:734-391-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251J00000XAgenciesNursing Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care