Provider Demographics
NPI:1205280054
Name:ROUTHIER, JESSICA BRYCE (LPC NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BRYCE
Last Name:ROUTHIER
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:ANDREW
Other - Last Name:ROUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC NCC
Mailing Address - Street 1:43000 W 9 MILE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4180
Mailing Address - Country:US
Mailing Address - Phone:313-356-6710
Mailing Address - Fax:810-534-7743
Practice Address - Street 1:2222 W GRAND RIVER AVE STE A
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1604
Practice Address - Country:US
Practice Address - Phone:313-356-6710
Practice Address - Fax:810-534-7743
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018744101YP2500X
MI6401016475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health