Active NPI
Brent Doornbos, LLMSW
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1295441707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851121023
- Practice address
- 300 68TH St SE
Grand Rapids, MI 49548-6927 - Phone
- (616) 455-5000
- Fax
- (616) 455-5960
- NPI assigned
- Jan 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health & Wellness Coach | 171400000X | |||
| Social Worker | 104100000X | 6851121023 | MI | Primary |
| Peer Specialist | 175T00000X |
Addresses
Primary practice location
300 68TH St SE
Grand Rapids, MI 49548-6927
Mailing address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 258-7500
Other practice location 1
1440 Fuller Ave SE
Grand Rapids, MI 49507-2191
Phone (616) 980-5390
Other practice location 2
Detroit Wayne Integrated Health Network
707 Milwaukee
Detroit, MI 48202
Phone (313) 418-5728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851121023 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760572800000",
"number": "1295441707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-258-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-455-5960"
}
],
"practiceLocations": [
{
"address_1": "1440 Fuller Ave SE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495072191",
"country_code": "US",
"telephone_number": "616-980-5390",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Detroit Wayne Integrated Health Network",
"address_2": "707 Milwaukee",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "48202",
"country_code": "US",
"telephone_number": "313-418-5728",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOORNBOS",
"first_name": "BRENT",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-27",
"last_updated": "2025-10-16",
"certification_date": "2025-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "171400000X",
"taxonomy_group": "",
"desc": "Health & Wellness Coach",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851121023",
"primary": true
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": false
}
],
"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 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.