Active NPI
Shelley Homolka, MA, LPC
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1487928511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401010905
- Practice address
- 3250 36TH St SE
Grand Rapids, MI 49512-8193 - Phone
- (616) 965-3476
- NPI assigned
- Mar 7, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401010905 | MI | Primary |
Addresses
Primary practice location
3250 36TH St SE
Grand Rapids, MI 49512-8193
Mailing address
3250 36TH St SE
Grand Rapids, MI 49512-8193
Phone (616) 965-3476
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 |
|---|---|---|---|
| 6401010905 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564531200000",
"number": "1487928511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3250 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495128193",
"telephone_number": "616-965-3476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495128193",
"telephone_number": "616-965-3476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOMOLKA",
"first_name": "SHELLEY",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-07",
"last_updated": "2019-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401010905",
"primary": true
}
],
"identifiers": [],
"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 Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.