Provider Demographics
NPI:1629677893
Name:JACKSON HEALING CLINIC LLC
Entity type:Organization
Organization Name:JACKSON HEALING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIEF CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STILTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, CTP-C
Authorized Official - Phone:734-726-4038
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-0365
Mailing Address - Country:US
Mailing Address - Phone:517-581-4710
Mailing Address - Fax:
Practice Address - Street 1:720 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1674
Practice Address - Country:US
Practice Address - Phone:517-581-4710
Practice Address - Fax:517-905-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty