Active NPI
Mark S Kane, PHD CSW
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1083722276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301009094
- Practice address
- 1015 Parchment Drive SE
Grand Rapids, MI 49546 - Phone
- (616) 464-0811
- Fax
- (616) 464-0812
- NPI assigned
- Aug 28, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301009094 | MI | Primary |
Addresses
Primary practice location
1015 Parchment Drive SE
Grand Rapids, MI 49546
Mailing address
1015 Parchment Drive SE
Grand Rapids, MI 49546
Phone (616) 464-0811
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)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Guidance Services | Psychologist | 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": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083722276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 PARCHMENT DRIVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49546",
"telephone_number": "616-464-0811",
"fax_number": "616-464-0812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 PARCHMENT DRIVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49546",
"telephone_number": "616-464-0811",
"fax_number": "616-464-0812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANE",
"first_name": "MARK",
"middle_name": "S",
"credential": "PHD CSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301009094",
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.