Provider Demographics
NPI:1801021803
Name:HAM, JENNIFER JANE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JANE
Last Name:HAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20300 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4105
Mailing Address - Country:US
Mailing Address - Phone:248-559-8190
Mailing Address - Fax:
Practice Address - Street 1:20300 CIVIC CENTER DR
Practice Address - Street 2:STE 303
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4105
Practice Address - Country:US
Practice Address - Phone:248-559-8190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional