Provider Demographics
NPI:1679751887
Name:CARNES, JESSICA A (SST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:CARNES
Suffix:
Gender:F
Credentials:SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617-9296
Mailing Address - Country:US
Mailing Address - Phone:231-882-4373
Mailing Address - Fax:
Practice Address - Street 1:6051 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9558
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-882-2360
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803084730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6803084730OtherSTATE OF MICHIGAN LICENSE