Provider Demographics
NPI:1104162783
Name:BAYYAPUNEEDI, JEANNETTE MARIE (LPC CAADC)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:BAYYAPUNEEDI
Suffix:
Gender:F
Credentials:LPC CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-3171
Mailing Address - Country:US
Mailing Address - Phone:269-267-6694
Mailing Address - Fax:
Practice Address - Street 1:4290 WINDING WAY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49004-3171
Practice Address - Country:US
Practice Address - Phone:269-267-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-30
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional