Provider Demographics
NPI:1205485497
Name:JEWELL, CONNOR KEONI (MA, LLPC)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:KEONI
Last Name:JEWELL
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 E OLD US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-2110
Mailing Address - Country:US
Mailing Address - Phone:734-719-0380
Mailing Address - Fax:734-292-8239
Practice Address - Street 1:14800 E OLD US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-2110
Practice Address - Country:US
Practice Address - Phone:734-719-0380
Practice Address - Fax:734-292-8239
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor