Provider Demographics
NPI:1952923500
Name:JEANNA BOASE, LLC
Entity Type:Organization
Organization Name:JEANNA BOASE, LLC
Other - Org Name:CULTIVATE WELLNESS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOASE
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:616-207-4655
Mailing Address - Street 1:6963 MARSHALL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6963 MARSHALL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7438
Practice Address - Country:US
Practice Address - Phone:616-207-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-16
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty