Provider Demographics
NPI:1881191203
Name:LUELLEN, JAZMIN LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:LYNN
Last Name:LUELLEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:LYNN
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2790 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2790 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6934
Practice Address - Country:US
Practice Address - Phone:989-491-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011150081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid