| Doctor Name: | JESSICA DETTMANN |
| NPI Number: | 1548409204 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 6401012407 |
| Business Practice Address: | 300 W Ferry St Berrien Springs, MI - 491031109 |
| Business Phone Number: | 2698155331 |
| Business Fax Number: | 2698155061 |
| Mailing Address: | 300 W Ferry St, BERRIEN SPRINGS |
| State: | MI |
| Postal Code: | 491031109 |
| Phone Number: | 2698155331 |
| Fax Number: | 2698155061 |
| NPI Enumeration Date: | 02/19/2009 |
| NPI Last Update Date: | 12/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401012407 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |