Katherine Devries Therapy, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KATHERINE DEVRIES THERAPY, PLLC

Practice address

5242 Plainfield Ave NE Ste E
Grand Rapids, MI 49525-1084

Phone

(616) 710-1033

NPI assigned

Aug 31, 2021

Last updated

Sep 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Katherine Ann Devries, LMSW, CAADCNPI 1841364924

Title

Owner

Phone

(616) 710-1033

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katherine Ann Devries, LMSW,CAAC

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1841364924
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1518635929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7880 5 MILE RD NE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493017749",
            "telephone_number": "616-881-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5242 PLAINFIELD AVE NE STE E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251084",
            "telephone_number": "616-710-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHERINE DEVRIES THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-710-1033",
        "authorized_official_credential": "LMSW, CAADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kathleen M. Eisin, DDS Ms PLLC
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• Kathryn Bultman L.L.C.

• 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 Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.