Organization Active NPI

Child Well Counseling, LLC

  • Mental Health Counselor
  • Jackson, MI
National Provider Identifier
1174358279
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CHILD WELL COUNSELING, LLC
Practice address
2301 E Michigan Ave
Jackson, MI 49202-3700
Phone
(517) 416-3115
NPI assigned
Sep 6, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Gayla Ignacio, LPCNPI 1275952285
Title
Owner
Phone
(517) 416-3115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2301 E Michigan Ave
Jackson, MI 49202-3700

Mailing address

624 Kennedy St
Jackson, MI 49202-3433
Phone (517) 416-3115

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1174358279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 KENNEDY ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023433",
            "telephone_number": "517-416-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 E MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023700",
            "telephone_number": "517-416-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD WELL COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "IGNACIO",
        "authorized_official_first_name": "GAYLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-416-3115",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.