Individual provider Active NPI

Melissa Muir, LLP

  • Counseling Psychologist
  • Grand Rapids, MI
National Provider Identifier
1124474820
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
6301016678 Issued in MI
Practice address
630 Kenmoor Ave SE Ste 101a
Grand Rapids, MI 49546-8626
Phone
(616) 446-8436
Fax
(616) 920-6536
NPI assigned
May 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 6361001766 MI
Counseling Psychologist 103TC1900X 6301016678 MI Primary

Addresses

Primary practice location

630 Kenmoor Ave SE Ste 101a
Grand Rapids, MI 49546-8626

Mailing address

630 Kenmoor Ave SE Ste 101a
Grand Rapids, MI 49546-8626
Phone (616) 446-8436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250818002799 MI Practitioner - Psychologist Billing Independently 5092241919 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1876 Millins Ave NW
Walker, MI 49534-2439

630 Kenmoor Ave SE
Suite 101a
Grand Rapids, MI 49546-8626

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6301016678MIMDCounseling Psychologist
6361001766MIMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Melissa Muir Counseling Services PLLC CurrentSince Jan 1, 2019 Accepting new patients
Clark Institute Psychology PLLC PastSince Oct 6, 2024 Accepting new patients
River City Psychological Services PC Counseling Past Accepting new patients

Locations

7150 Kalamazoo Ave SE
Ste C
Caledonia, MI 49316
Phone (616) 219-0159

630 Kenmoor Ave SE
Ste 101A
Grand Rapids, MI 49546
Phone (616) 204-5589

Organizations & group practices 3

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": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1124474820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 KENMOOR AVE SE STE 101A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468626",
            "telephone_number": "616-446-8436",
            "fax_number": "616-920-6536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 KENMOOR AVE SE STE 101A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468626",
            "telephone_number": "616-446-8436",
            "fax_number": "616-920-6536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUIR",
        "first_name": "MELISSA",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-11",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6361001766",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301016678",
            "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 Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.