Active NPI
Benjamin Russell Wilson, LLPC
- Professional Counselor
- Bellevue, MI
National Provider Identifier
1093257461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401015351
- Practice address
- 6461 Dawn Dr
Bellevue, MI 49021-8411 - Phone
- (269) 986-2844
- NPI assigned
- Nov 16, 2016
- Last updated
- Nov 16, 2016
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401015351 | MI | Primary |
Addresses
Primary practice location
6461 Dawn Dr
Bellevue, MI 49021-8411
Mailing address
6461 Dawn Dr.
Bellevue, MI 49021
Phone (269) 986-2844
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 |
|---|---|---|---|
| 6401015351 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479254400000",
"number": "1093257461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6461 DAWN DR.",
"city": "BELLEVUE",
"state": "MI",
"postal_code": "49021",
"telephone_number": "269-986-2844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6461 DAWN DR",
"city": "BELLEVUE",
"state": "MI",
"postal_code": "490218411",
"telephone_number": "269-986-2844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BENJAMIN",
"middle_name": "RUSSELL",
"name_prefix": "Mr.",
"credential": "LLPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-16",
"last_updated": "2016-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401015351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.