Active NPI
Kyra Roberts, LCMHCA
- Mental Health Counselor
- Grand Rapids, MI
National Provider Identifier
1043057219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6451023959
- Practice address
- 3351 Claystone St SE Ste G32
Grand Rapids, MI 49546-5794 - Phone
- (352) 238-1608
- NPI assigned
- Jul 13, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6451023959 | MI | Primary |
Addresses
Primary practice location
3351 Claystone St SE Ste G32
Grand Rapids, MI 49546-5794
Mailing address
51771 Pleasant Dr
Mattawan, MI 49071
Phone (352) 238-1608
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6451023959 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730764800000",
"number": "1043057219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51771 PLEASANT DR",
"city": "MATTAWAN",
"state": "MI",
"postal_code": "49071",
"telephone_number": "352-238-1608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3351 CLAYSTONE ST SE STE G32",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495465794",
"telephone_number": "352-238-1608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KYRA",
"credential": "LCMHCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-13",
"last_updated": "2024-11-05",
"certification_date": "2024-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6451023959",
"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 Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.