The Open Road Collective LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE OPEN ROAD COLLECTIVE LLC

Practice address

717 W Ellsworth Rd
Ann Arbor, MI 48108-3343

Phone

(734) 678-3097

NPI assigned

Dec 21, 2023

Last updated

Dec 21, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Corryn Helen Jackson, LPCNPI 1841802469

Title

Owner

Phone

(734) 678-3097

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corryn Helen Jackson, LPC

  • Professional Counselor
  • Dearborn, MI
  • NPI 1841802469
  NPD Authorized official

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

{
    "created_epoch": "1703116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1467221218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 WARNER ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481974658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 W ELLSWORTH RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481083343",
            "telephone_number": "734-678-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OPEN ROAD COLLECTIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-21",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CORRYN",
        "authorized_official_middle_name": "HELEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-678-3097",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; 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.