Third Age Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THIRD AGE COUNSELING LLC

Practice address

2020 Raybrook St SE Ste 203
Grand Rapids, MI 49546-7717

Phone

(616) 490-9118

NPI assigned

Dec 12, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Cheryl A Corcoran, LMSW

Title

Principal

Phone

(616) 490-9118

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1544572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558396800000",
    "number": "1598236804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 RAYBROOK ST SE STE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 RAYBROOK ST SE STE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467717",
            "telephone_number": "616-490-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD AGE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-12",
        "last_updated": "2019-05-21",
        "status": "A",
        "authorized_official_last_name": "CORCORAN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "616-490-9118",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.

Verify at the official NPI Registry.