Active NPI
Lucas Koole, LPC
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1023473121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401019158
- Practice address
- 300 68TH St SE
Grand Rapids, MI 49548-6927 - Phone
- (616) 455-5000
- Fax
- (616) 455-5960
- NPI assigned
- Dec 16, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH60629508 | WA | |
| Professional Counselor | 101YP2500X | 6401019158 | MI | Primary |
Addresses
Primary practice location
300 68TH St SE
Grand Rapids, MI 49548-6927
Mailing address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000
Other practice location 1
3083 Washington Ave SW Ste B-4
Grandville, MI 49418-1588
Phone (616) 443-8785
Other practice location 2
30 Jefferson Ave SE
Grand Rapids, MI 49503-4304
Phone (616) 443-8785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 31, 2024 through Dec 31, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH60629508 | WA | MD | Mental Health Counselor |
| 6401019158 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1023473121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-455-5960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-455-5960"
}
],
"practiceLocations": [
{
"address_1": "3083 Washington Ave SW Ste B-4",
"address_purpose": "LOCATION",
"city": "Grandville",
"state": "MI",
"postal_code": "494181588",
"country_code": "US",
"telephone_number": "616-443-8785",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "30 Jefferson Ave SE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495034304",
"country_code": "US",
"telephone_number": "616-443-8785",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOOLE",
"first_name": "LUCAS",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-16",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH60629508",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401019158",
"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 Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.