Provider Demographics
NPI:1972679843
Name:O GRADY, JANE LOUISE (MFT LPC LLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LOUISE
Last Name:O GRADY
Suffix:
Gender:F
Credentials:MFT LPC LLP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LOUISE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5340 HOLIDAY TERRACE
Mailing Address - Street 2:CHILD & FAMILY PSYCHOLOGICAL SERVICES
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:269-372-4140
Mailing Address - Fax:269-372-0390
Practice Address - Street 1:5340 HOLIDAY TERRACE
Practice Address - Street 2:CHILD & FAMILY PSYCHOLOGICAL SERVICES
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-372-4140
Practice Address - Fax:269-372-0390
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007872101YP2500X
MI6301011029103T00000X
MI4101006170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist