Provider Demographics
NPI:1336950732
Name:JAYANTI MISHRA, PLLC
Entity type:Organization
Organization Name:JAYANTI MISHRA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSELOR/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAYANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PHD
Authorized Official - Phone:630-864-1345
Mailing Address - Street 1:1380 COOLIDGE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7068
Mailing Address - Country:US
Mailing Address - Phone:248-494-8424
Mailing Address - Fax:
Practice Address - Street 1:1380 COOLIDGE HWY STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7068
Practice Address - Country:US
Practice Address - Phone:248-494-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty