Provider Demographics
NPI:1730436700
Name:RICH, JENNIFER CHAILLE (MA LLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHAILLE
Last Name:RICH
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 PACKARD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2060
Mailing Address - Country:US
Mailing Address - Phone:734-528-9703
Mailing Address - Fax:734-572-8866
Practice Address - Street 1:2900 PACKARD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2060
Practice Address - Country:US
Practice Address - Phone:734-528-9703
Practice Address - Fax:734-572-8866
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010136329103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling