Jacob Brown

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

6362009526 Issued in MI

Practice address

201 W Washington Ave Ste 280
Zeeland, MI 49464-1074

Phone

(616) 259-5452

Fax

(616) 236-0875

NPI assigned

Apr 5, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Headwaters Counseling, LLC

  • Clinical Psychologist
  • Zeeland, MI
  • NPI 1184172272

  MI

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1114770658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W WASHINGTON AVE STE 280",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494641074",
            "telephone_number": "616-259-5452",
            "fax_number": "616-236-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W WASHINGTON AVE STE 280",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494641074",
            "telephone_number": "616-259-5452",
            "fax_number": "616-236-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "6362009526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Petra Braunius
• Katelyn Bredeweg, MSN RN AGCNS-BC ONC
• Deborah Brink, LMSW
• Angela Brown, LMSW
• Anthony M Brown
• Katie Jo Bruins
• Sophia Bultema
• Bunte'S Pharmacy, Inc
• Bunte'S Pharmacy, Inc
• William Jason Burgess IV, MS, AT, ATC, CSCS

• All providers in Zeeland, MI
• Cognitive & Behavioral Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.