NPIMap

Individual provider Active NPI

Grant Thomas Willms, M.MIN.

  • Mental Health Counselor
  • Council Bluffs, IA
National Provider Identifier
1376850016
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
04986 Issued in IA
Practice address
20 Frank St
Council Bluffs, IA 51503-4460
Phone
(712) 323-4478
Fax
(712) 323-4188
NPI assigned
Sep 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 04986 IA
Mental Health Counselor 101YM0800X 04986 IA Primary
Pastoral Counselor 101YP1600X 04986 IA
Professional Counselor 101YP2500X 04986 IA
Clinical Social Worker 1041C0700X 04986 IA
Marriage & Family Therapist 106H00000X 04986 IA

Addresses

Primary practice location

20 Frank St
Council Bluffs, IA 51503-4460

Mailing address

2132 S 42ND St
Omaha, NE 68105-2910
Phone (402) 558-1858

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

LicenseStateTypeSpecialty
04986IAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
James Severa Past Accepting new patients
James D. Severa Mental Health Past Accepting new patients

Organizations & group practices 2

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": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1376850016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2132 S 42ND ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681052910",
            "telephone_number": "402-558-1858",
            "fax_number": "402-558-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FRANK ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034460",
            "telephone_number": "712-323-4478",
            "fax_number": "712-323-4188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLMS",
        "first_name": "GRANT",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "M.MIN.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-01",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IA",
            "license": "04986",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "04986",
            "primary": true
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "IA",
            "license": "04986",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IA",
            "license": "04986",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "04986",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IA",
            "license": "04986",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; 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.