Jeffrey Alan Bootzin, EDS, LLP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6301002673 Issued in MI

Practice address

330 Eastern Ave SE
Grand Rapids, MI 49503-4737

Phone

(616) 776-0891

Fax

(616) 233-0672

NPI assigned

Sep 30, 2008

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Life Guidance Services

  • Social Worker
  • Grand Rapids, MI
  • NPI 1336185032
  NPD (past)
• Project Rehab

  • Substance Abuse Rehabilitation Facility
  • Grand Rapids, MI
  • NPI 1104986603
  NPD (past)

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222732800000",
    "number": "1295986933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-776-0891",
            "fax_number": "616-233-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034737",
            "telephone_number": "616-776-0891",
            "fax_number": "616-233-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTZIN",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "EDS, LLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-30",
        "last_updated": "2008-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301002673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marshall Alan Boose, D.O.
• Greg Allen Booth Vander Wel, LPN
• Andrew D Booth, PA
• Kristy Lynn Booth, PA
• Tracy Marie Booth, MA, RDN
• Lauren Bootzin, MD
• Chad Michael Boprie, CTRS, ATRIC
• Kelly Sue Boprie, LMSW
• Nirali Bora, M.D.
• William Boras III, O.D.

• Counseling Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Counseling Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.