Active NPI
Ardean Beth Brock-Vanderwall, M.DIV., M.A.
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1013147495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401011131
- Practice address
- 2828 Kraft Ave.
Grand Rapids, MI 49512 - Phone
- (616) 949-9550
- Fax
- (616) 949-9551
- NPI assigned
- Jul 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401011131 | MI | Primary |
Addresses
Primary practice location
2828 Kraft Ave.
Grand Rapids, MI 49512
Mailing address
3208 Woodberry Drive
Grand Rapids, MI 49512
Phone (616) 893-6420
Other names 1
- Ardean Beth Brock-Vanderwall
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401011131 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445817600000",
"number": "1013147495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3208 WOODBERRY DRIVE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49512",
"telephone_number": "616-893-6420",
"fax_number": "616-891-9676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 KRAFT AVE.",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49512",
"telephone_number": "616-949-9550",
"fax_number": "616-949-9551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK-VANDERWALL",
"first_name": "ARDEAN",
"middle_name": "BETH",
"credential": "M.DIV., M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-20",
"last_updated": "2015-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401011131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ARDEAN",
"last_name": "BROCK-VANDERWALL",
"middle_name": "BETH",
"credential": "M.DIV., M.A.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.