Individual provider Active NPI

Jessica Dianne Niland, LLPC, TLLP

  • Professional Counselor
  • Kalamazoo, MI
National Provider Identifier
1457698946
Registry record updated Jan 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401013385 Issued in MI
Practice address
610 S Burdick St
Kalamazoo, MI 49007-5221
Phone
(269) 381-3700
Fax
(269) 381-3810
NPI assigned
Jan 3, 2013
Last updated
Jan 3, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401013385 MI Primary
Counseling Psychologist 103TC1900X 6301015336 MI

Addresses

Primary practice location

610 S Burdick St
Kalamazoo, MI 49007-5221

Mailing address

610 S Burdick St
Kalamazoo, MI 49007-5221
Phone (269) 381-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240716000133 MI Practitioner - Mental Health Counselor 3971048828 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401013385MIMDProfessional Counselor
6301015336MIMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Apr 23, 2024 Accepting new patients
Optum Behavioral Care of Colorado, P.C. Counseling CurrentSince Apr 23, 2024 Accepting new patients

Locations

5340 Holiday Ter
Kalamazoo, MI 49009
Phone (269) 372-4140

1662 E Centre Ave
Portage, MI 49002
Phone (269) 321-8564

1662 E Centre Ave
Ste B
Portage, MI 49002
Phone (269) 321-8564

Interoperability endpoints

  • Direct secure messaging: jessica.niland.1@28621.direct.athenahealth.com

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

NPI Registry JSON

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

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357171200000",
    "number": "1457698946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 S BURDICK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075221",
            "telephone_number": "269-381-3700",
            "fax_number": "269-381-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 S BURDICK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075221",
            "telephone_number": "269-381-3700",
            "fax_number": "269-381-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILAND",
        "first_name": "JESSICA",
        "middle_name": "DIANNE",
        "credential": "LLPC, TLLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-03",
        "last_updated": "2013-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013385",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301015336",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.