Provider Demographics
NPI:1982597878
Name:JUPITER HEALING
Entity type:Organization
Organization Name:JUPITER HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:231-570-2510
Mailing Address - Street 1:5292 VOICE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9607
Mailing Address - Country:US
Mailing Address - Phone:231-570-0251
Mailing Address - Fax:
Practice Address - Street 1:5292 VOICE RD
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9607
Practice Address - Country:US
Practice Address - Phone:231-570-0251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty