Blue Water Serenity Counseling PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BLUE WATER SERENITY COUNSELING PLLC

Practice address

5429 Shorewood Dr
Fort Gratiot, MI 48059-3138

Phone

(810) 357-1725

Fax

(810) 824-4865

NPI assigned

Nov 19, 2014

Last updated

Dec 8, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexis Johnson, LMSW,CADCNPI 1609118637

Title

Owner and Sole Proprietor

Phone

(810) 824-4865

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexis Johnson, LMSW, CADC

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1609118637
  Authorized official Same address or phone

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1023415072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5429 SHOREWOOD DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593138",
            "telephone_number": "810-357-1725",
            "fax_number": "810-824-4865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 SHOREWOOD DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593138",
            "telephone_number": "810-357-1725",
            "fax_number": "810-824-4865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER SERENITY COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "OWNER AND SOLE PROPRIETOR",
        "authorized_official_telephone_number": "810-824-4865",
        "authorized_official_credential": "LMSW,CADC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER IDENTIFICATION",
            "identifier": "1609118637",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blue Water Family Dentistry PC
• Blue Water Mental Health Clinic (Blue Water Counseling)
• Blue Water Mental Health Clinic
• Blue Water Nursing Center (Evangelical Home - Port Huron)
• Blue Water Primary Care
• Blue Water Sleep Inc
• Blue Water Urgent Care PLLC
• Blue Water Voice LLC
• Karlene Bognar
• Jessica Bohm

• Clinical Social Worker in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.