Thomas Daniel Jachulski, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801097000 Issued in MI

Practice address

3225 N Evergreen Dr NE
Grand Rapids, MI 49525

Phone

(616) 364-1500

NPI assigned

Jan 21, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD
• Pine Rest Christian Mental Health Services

  • Social Worker
  • Grand Rapids, MI
  • NPI 1922019157
  NPD
• Carla Miller Ma MSW

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1942334669
  NPD (past)
• Telebehavioral Health US

  • Clinical Social Worker
  • Belmont, MI
  • NPI 1194252692
  NPD (past)

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1508255001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-364-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 Thornapple River Dr SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495469706",
            "country_code": "US",
            "telephone_number": "616-558-5345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACHULSKI",
        "first_name": "THOMAS",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-21",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801097000",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan K Jabin, OTR/L
• Gary Williams Jablonski, R.PH.
• Amy Marie Jachalke, LMSW
• Matthew D Jachalke, LMSW
• Savannah Jachim
• Geraldine Marie Jack, BS, ETS
• Katherine Jack, LPC
• Brandi Jackman
• Darren Robert Jacks, PHARMD
• Kali Mackenzie Jackson-Dieleman, LMSW-C, CAADC-DP

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.