NPIMap

Organization Active NPI

139 Education, LLC.

  • Psychologist
  • Grandville, MI
National Provider Identifier
1013294628
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301009353 Issued in MI
Legal business name
139 EDUCATION, LLC.
Practice address
3148 44TH St SW
Grandville, MI 49418
Phone
(800) 600-4096
Fax
(800) 606-8839
NPI assigned
Nov 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy Royer, PSYNPI 1326388554
Title
Provider/Authorized Official
Phone
(800) 600-4096

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 6301009353 MI Primary

Addresses

Primary practice location

3148 44TH St SW
Grandville, MI 49418

Mailing address

201 Monroe Ave NW
Suite 300
Grand Rapids, MI 49503
Phone (800) 600-4096

Other identifiers 1

IdentifierTypeStateIssuer
0D14689OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN

Other names 1

  • Neurocore Doing business as

National Provider Directory

National Provider Directory
Tax ID family
139 Education LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 Monroe Ave NW
Ste 300
Grand Rapids, MI 49503

3148 44th St SW
Grandville, MI 49418
Phone (616) 228-0770

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1013294628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MONROE AVE NW",
            "address_2": "SUITE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "800-600-4096",
            "fax_number": "800-606-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3148 44TH ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "49418",
            "telephone_number": "800-600-4096",
            "fax_number": "800-606-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "139 EDUCATION, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-10",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "ROYER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PROVIDER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "800-600-4096",
        "authorized_official_credential": "PSY"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301009353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "0D14689",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurocore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grandville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.