Jessica Lynn Mangan, MA, LPC, LLP

Primary specialty

CounselorTaxonomy code 101Y00000X

License

6401009818 Issued in MI

Practice address

300 68TH St SE
Grand Rapids, MI 49548-6927

Phone

(616) 455-5270

Fax

(616) 455-5460

NPI assigned

Dec 13, 2006

Sex

Female

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hope Network

  • Community/Behavioral Health Agency
  • Grand Rapids, MI
  • NPI 1720316953
  NPD (past)
• Hope Network Behavioral Health Services

  • Mental Illness Community Based Residential Treatment Facility
  • Nunica, MI
  • NPI 1043295934
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1720149685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12895 WOODGROVE DR",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788872",
            "telephone_number": "269-598-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5270",
            "fax_number": "616-455-5460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12895 Woodgrove Dr",
            "address_purpose": "LOCATION",
            "city": "South Lyon",
            "state": "MI",
            "postal_code": "481788872",
            "country_code": "US",
            "telephone_number": "269-598-8780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC, LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361000886",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401009818",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401009818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anjali Modi Mander, M.D.
• Navneet Singh Mander, M.D.
• Amy Manderscheid, DNP, RN, AGPCNP-BC
• Sean Mandle, ATC
• Anne Marie Manees, PSY.D.
• Omar Mangrum, EDD
• Carley Mangus, PT, DPT
• Caitlyn Maniaci
• Nathaniel Maniaci, MD
• Isabel Renee Manilla, PT, DPT

• Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.