Jalen Kainick Bogan, M.A, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

6401223573 Issued in MI

Practice address

1200 N West Ave
Jackson, MI 49202-2179

Phone

(517) 789-1209

NPI assigned

Jan 25, 2021

Last updated

Oct 28, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1043800956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2755 GRANADA DR APT 1C",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492025257",
            "telephone_number": "269-578-6389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N WEST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022179",
            "telephone_number": "517-789-1209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 W Willow St",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489171833",
            "country_code": "US",
            "telephone_number": "517-323-4734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOGAN",
        "first_name": "JALEN",
        "middle_name": "KAINICK",
        "name_prefix": "Mr.",
        "credential": "M.A,  LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-25",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401223573",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401019007",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Marie Blum, PA-C
• Douglas William Blume, MA LLPC
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• Nina Marie Bock, PA-C
• Aida Bodour, M.D.
• Kelli Lynn Bogue, AU.D.
• Kevin Scott Bohlen, PA-C
• Amber Lyn Bohnett-Smith, MA, LLPC, NCC
• Bok Medical Service
• Amanda Joyce Bolanowski, LLMSW

• Counselor in Jackson, MI
• Providers in Jackson, MI by specialty
• Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.