Provider Demographics
NPI:1306957444
Name:JACKSON BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:JACKSON BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:517-780-0809
Mailing Address - Street 1:209 E WASHINGTON AVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2393
Mailing Address - Country:US
Mailing Address - Phone:517-780-0809
Mailing Address - Fax:517-788-5922
Practice Address - Street 1:209 E WASHINGTON AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2393
Practice Address - Country:US
Practice Address - Phone:517-780-0809
Practice Address - Fax:517-788-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010119103TC0700X
MI6302006268103TC0700X
MI4301044183261QM1300X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty