Theodore J Jansma Jr., PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301001233 Issued in MI

Practice address

3330 Claystone St SE
Grand Rapids, MI 49546-7716

Phone

(616) 942-8060

Fax

(616) 942-6690

NPI assigned

Dec 29, 2005

Last updated

Jun 26, 2008By the provider in NPPES

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)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Claystone Clinical Associates PLC

  • Psychiatry Physician
  • Grand Rapids, MI
  • NPI 1336668698
  NPD (past)

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214438400000",
    "number": "1316924525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30516",
            "address_2": "DEPT 6065",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489098016",
            "telephone_number": "616-532-8000",
            "fax_number": "616-532-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 CLAYSTONE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467716",
            "telephone_number": "616-942-8060",
            "fax_number": "616-942-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSMA",
        "first_name": "THEODORE",
        "middle_name": "J",
        "name_suffix": "Jr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2008-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301001233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Jansen, P.T.
• Jansma Family Eye Care Inc
• Ashley Jansma, LPC
• Erica S Jansma, LMSW
• Shannon M Jansma, PA-C
• Jeanna Beth Janssen
• Janus RX LLC (Janus Rx)
• Mackenzie Janusz
• Connie Januzelli, DO
• Amanda N Janvier

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.