| Jenelle Mazaris, | |
| 
					705 S Main St, Suite 280, Plymouth, MI 48170-2089  | |
| (734) 454-3560 | |
| (734) 454-3570 | 
| Full Name | Jenelle Mazaris | 
|---|---|
| Gender | Female | 
| Speciality | Marriage & Family Therapist | 
| Location | 705 S Main St, Plymouth, Michigan | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1700247962 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 4101006577 (Michigan) | Primary | 
| Entity Name | Holistic Drama Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1700380664 PECOS PAC ID: 9335668144 Enrollment ID: O20250524000125  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Jenelle Mazaris, 3694 Clarkston Rd, Suite D, Clarkston, MI 48348-5213 Ph: (248) 410-0650  | Jenelle Mazaris, 705 S Main St, Suite 280, Plymouth, MI 48170-2089 Ph: (734) 454-3560  | 
Zain Shamoon, LLMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 705 S Main St, Suite 280, Plymouth, MI 48170 Phone: 734-454-3560  | |
Mr. Mark Phelps, M.A., L.M.F.T. Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 705 S Main St Ste 280, Plymouth, MI 48170 Phone: 734-454-3560  | |
Matthew Buryta, LLMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 696 N Mill St Ste 107, Plymouth, MI 48170 Phone: 734-231-8190  |