Active NPI
Elizabeth Marie Coyne
- Counselor
- Grand Rapids, MI
National Provider Identifier
1053023978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1115 Ball Ave NE
Grand Rapids, MI 49505-5904 - Phone
- (616) 456-6571
- NPI assigned
- Dec 22, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Mailing address
854 N Ottillia St SE
Grand Rapids, MI 49507-3737
Phone (616) 822-0701
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1051516432 | Medicaid | MI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1053023978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "854 N OTTILLIA ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495073737",
"telephone_number": "616-822-0701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 BALL AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495055904",
"telephone_number": "616-456-6571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COYNE",
"first_name": "ELIZABETH",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-22",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1051516432",
"state": "MI"
}
],
"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 Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.