Active NPI
Michele A Nielsen, MA, LLP, LLPC
- Clinical Psychologist
- Grand Rapids, MI
National Provider Identifier
1457527020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301013548
- Practice address
- 200 Ionia Ave SW
Suite 4112
Grand Rapids, MI 49503-4116 - Phone
- (616) 283-3120
- NPI assigned
- May 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301013548 | MI | Primary |
| Counseling Psychologist | 103TC1900X | 6401010610 | MI |
Addresses
Primary practice location
200 Ionia Ave SW
Suite 4112
Grand Rapids, MI 49503-4116
Mailing address
200 Ionia Ave SW
Suite 4112
Grand Rapids, MI 49503-4116
Phone (616) 283-3120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | NONE |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013548 | MI | MD | Clinical Psychologist |
| 6401010610 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260144000000",
"number": "1457527020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 IONIA AVE SW",
"address_2": "SUITE 4112",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034116",
"telephone_number": "616-283-3120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 IONIA AVE SW",
"address_2": "SUITE 4112",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034116",
"telephone_number": "616-283-3120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "MICHELE",
"middle_name": "A",
"credential": "MA, LLP, LLPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-05",
"last_updated": "2009-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301013548",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6401010610",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "NONE",
"state": null
}
],
"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 Dec 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.