Provider Demographics
NPI:1134592090
Name:JANSEN, LEANNE (MA, LLPC, NCC)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:JANSEN
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7006
Mailing Address - Country:US
Mailing Address - Phone:616-308-2389
Mailing Address - Fax:
Practice Address - Street 1:1044 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7006
Practice Address - Country:US
Practice Address - Phone:616-308-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional