Jessica Lynn Mangan, MA, LPC, LLP
Counselor in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1720149685
StatusActive
Last updated in NPPESSep 24, 2024
Details
- NPI
- 1720149685
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Jessica Lynn Mangan
- Credential
- MA, LPC, LLP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 13, 2006
- Certification date
- Sep 24, 2024
- Last updated
- Sep 24, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101Y00000X | Counselor | 6401009818 | MI | Yes |
| 103T00000X | Psychologist | 6361000886 | MI | |
| 101YP2500X | Counselor, Professional | 6401009818 | MI |
Practice location
300 68th St SeGrand Rapids, MI 49548-6927
Phone 616-455-5270 · Fax 616-455-5460
Mailing address
12895 Woodgrove DrSouth Lyon, MI 48178-8872
Phone 269-598-8780
Other practice locations
12895 Woodgrove Dr
South Lyon, MI 48178-8872
South Lyon, MI 48178-8872
Phone 269-598-8780
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