Provider Demographics
NPI:1538148796
Name:POPPE, JEAN M (MA, LLP, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:POPPE
Suffix:
Gender:F
Credentials:MA, LLP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1919
Mailing Address - Country:US
Mailing Address - Phone:269-382-3636
Mailing Address - Fax:269-382-3606
Practice Address - Street 1:605 HOWARD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1919
Practice Address - Country:US
Practice Address - Phone:269-382-3636
Practice Address - Fax:269-382-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009340101YP2500X
MI6301010895103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling