Active NPI
Brian Willshire
- Professional Counselor
- Kalamazoo, MI
National Provider Identifier
1053825588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401004052
- Practice address
- 251 N Rose St
Kalamazoo, MI 49007-3860 - Phone
- (616) 228-1286
- NPI assigned
- Nov 20, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401004052 | MI | Primary |
Addresses
Primary practice location
251 N Rose St
Kalamazoo, MI 49007-3860
Mailing address
10031 Deer Sight Dr
Middleville, MI 49333-8006
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14135643 | Other | MI | CAQH |
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 |
|---|---|---|---|
| 6401004052 | MI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Journey PLLC | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
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": "1511136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1053825588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10031 DEER SIGHT DR",
"city": "MIDDLEVILLE",
"state": "MI",
"postal_code": "493338006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 N ROSE ST",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490073860",
"telephone_number": "616-228-1286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLSHIRE",
"first_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-20",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401004052",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "14135643",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.