Provider Demographics
NPI:1801509922
Name:PRIEST, JESSICA R (LLPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:PRIEST
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5814 CROY LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-9521
Mailing Address - Country:US
Mailing Address - Phone:231-384-5595
Mailing Address - Fax:
Practice Address - Street 1:5814 CROY LAKE RD NE
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-9521
Practice Address - Country:US
Practice Address - Phone:231-384-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6541022275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional