Provider Demographics
NPI:1740687953
Name:MISSION ASSESSMENTS & PERSONALIZED SERVICES, LLC
Entity type:Organization
Organization Name:MISSION ASSESSMENTS & PERSONALIZED SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - LICENSED PROF. COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:734-883-4812
Mailing Address - Street 1:5229 W MICHIGAN AVE LOT 185
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9178
Mailing Address - Country:US
Mailing Address - Phone:734-883-4812
Mailing Address - Fax:734-434-2043
Practice Address - Street 1:5229 W MICHIGAN AVE LOT 185
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9178
Practice Address - Country:US
Practice Address - Phone:734-883-4812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB6437V251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health