Active NPI
Kelly James Bonewell, PHD, LPC
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1013931872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401008653
- Practice address
- 977 Ada Place Dr SE
Grand Rapids, MI 49546-8412 - Phone
- (616) 460-3341
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- 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 | 6401008653 | MI | Primary |
Addresses
Primary practice location
977 Ada Place Dr SE
Grand Rapids, MI 49546-8412
Mailing address
3721 Dursum Ave NE
Ada, MI 49301-9718
Phone (616) 308-1503
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401008653 | MI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellspring Counseling | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Voluntary or Charitable Agency
- Grand Rapids, MI
- NPI 1962424887
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589155200000",
"number": "1013931872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3721 DURSUM AVE NE",
"city": "ADA",
"state": "MI",
"postal_code": "493019718",
"telephone_number": "616-308-1503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "977 ADA PLACE DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468412",
"telephone_number": "616-460-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONEWELL",
"first_name": "KELLY",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "PHD, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401008653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.