Individual provider Active NPI

Jaclyn Myers, LMSW

  • Social Worker
  • Clinton Township, MI
National Provider Identifier
1023405032
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801108181 Issued in MI
Practice address
42669 Garfield Rd # 326
Clinton Township, MI 48038-1653
Phone
(586) 412-5321
NPI assigned
Apr 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801099725 MI
Clinical Social Worker 1041C0700X 6801108181 MI
Social Worker 104100000X 6801108181 MI Primary

Addresses

Primary practice location

42669 Garfield Rd # 326
Clinton Township, MI 48038-1653

Mailing address

6549 Town Center Dr Ste a
Clarkston, MI 48346-4824
Phone (248) 620-6400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201104000667 MI Practitioner - Clinical Social Worker 3476963349 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801099725MIMDSocial Worker
6801108181MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
You Matter Therapy Solutions Inc CurrentSince Oct 23, 2023 Accepting new patients
Blooming Therapy LLC PastSince Jul 13, 2021 Accepting new patients

Locations

37400 Garfield Rd
Clinton Twp, MI 48036
Phone (586) 263-5220

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1023405032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6549 TOWN CENTER DR STE A",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483464824",
            "telephone_number": "248-620-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42669 GARFIELD RD # 326",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381653",
            "telephone_number": "586-412-5321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "JACLYN",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-17",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801099725",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801108181",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801108181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.