Individual provider Active NPI

Keith Anthony Louwerse, PSYD

  • Clinical Psychologist
  • Zeeland, MI
National Provider Identifier
1174750459
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301015112 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
Jun 15, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301015112 MI Primary

Addresses

Primary practice location

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

Mailing address

201 W Washington Ave Ste 280
Zeeland, MI 49464-1074
Phone (616) 259-5452

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120911000676 MI Practitioner - Clinical Psychologist 4082800834 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Headwaters Counseling, LLCGroup PAC ID 8123374667, 2 clinicians

Practice addresses (Care Compare)

201 W Washington Ave
Zeeland, MI 49464-1074
Phone (616) 259-5452

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6301015112MIMDClinical Psychologist
71AKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Headwaters Counseling, LLC Clinical CurrentSince Jan 1, 2017 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jun 16, 2012 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jun 16, 2012 Accepting new patients

Locations

770 Kenmoor Ave SE
Ste 101
Grand Rapids, MI 49546

186 S River Ave
Ste 5
Holland, MI 49423
Phone (616) 259-5452

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

201 W Washington Ave
Ste 280
Zeeland, MI 49464
Phone (616) 259-5452

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": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1174750459",
    "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": "LOUWERSE",
        "first_name": "KEITH",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-15",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zeeland, MI

Sources for this page

Verify at the official NPI Registry.