Thea Woodnorth Counseling Services LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

THEA WOODNORTH COUNSELING SERVICES LLC

Practice address

2040 Raybrook St SE Ste 301D
Grand Rapids, MI 49546-7775

Phone

(616) 304-0274

Fax

(517) 323-9531

NPI assigned

Dec 17, 2021

Organization subpart

No

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

Authorized official

Name

Cathy Gallegos

Title

Credentialing Manager

Phone

(517) 483-2461

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1144989146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 BLYTHE CT NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495042530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 RAYBROOK ST SE STE 301D",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467775",
            "telephone_number": "616-304-0274",
            "fax_number": "517-323-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEA WOODNORTH COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-17",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "GALLEGOS",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "517-483-2461"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Thekey of Michigan LLC

• Professional Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.