Provider Demographics
NPI:1326849225
Name:MCNUTT, JENIFER (LPC)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:MCNUTT
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14832 ROSSINI DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1947
Mailing Address - Country:US
Mailing Address - Phone:313-588-0025
Mailing Address - Fax:
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2212
Practice Address - Country:US
Practice Address - Phone:248-530-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401225012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional