Individual provider Active NPI

John Mark Stitzel Jr., LPC

  • Professional Counselor
  • Grand Rapids, MI
National Provider Identifier
1508096835
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401009202 Issued in MI
Practice address
790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone
(616) 336-3909
Fax
(616) 336-8830
NPI assigned
Jul 21, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401009202 MI Primary

Addresses

Primary practice location

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

Mailing address

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 336-3909

Other practice location 1

805 Leonard St NE
Grand Rapids, MI 49503-1138
Phone (616) 710-2320

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pcerecords.network180.x@direct.mihin.net Direct

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
6401009202MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
D a Blodgett-St Johns PastSince Oct 10, 2015 Accepting new patients

Organizations & group practices 1

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": "1248134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1508096835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Leonard St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495031138",
            "country_code": "US",
            "telephone_number": "616-710-2320",
            "fax_number": "616-774-3842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STITZEL",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-21",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401009202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcerecords.network180.x@direct.mihin.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "790 Fuller Ave NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495031918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Apr 6, 2022; 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.