Jacquelyn Aurora Thomas, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801106889 Issued in MI

Practice address

4433 Byron Center Ave SW Ste C
Wyoming, MI 49519-4844

Phone

(616) 279-1551

NPI assigned

Aug 26, 2020

Sex

Female

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Portal Point Counseling, LLC

  • Social Worker
  • Wyoming, MI
  • NPI 1689134074
  Medicare reassignment NPD

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1144833468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2178 BYRON SHORES DR SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493158087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4433 BYRON CENTER AVE SW STE C",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495194844",
            "telephone_number": "616-279-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JACQUELYN",
        "middle_name": "AURORA",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801106889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Nurturing Company, LLC
• Therapeutic Resolutions, LLC
• Third Age Counseling LLC
• Derek James Thocker, MA, BCBA
• Thomas W Pfennig DO
• Laura Elizabeth Thomas
• Ryan Matthew Thomas, DC
• Jared Thompson, D.O.
• Nicole Thompson
• Olivia Rae Thompson

• Clinical Social Worker in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.