Michael D Soukup, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801019792 Issued in MI

Practice address

40 Jefferson Ave SE
Grand Rapids, MI 49503-4304

Phone

(616) 356-6285

Fax

(616) 732-6392

NPI assigned

Feb 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629112933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1681 WOLVERINE ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494236741",
            "telephone_number": "616-335-2820",
            "fax_number": "616-732-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034304",
            "telephone_number": "616-356-6285",
            "fax_number": "616-732-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKUP",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801019792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "7509106890",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Teresa Soto, PSS
• Milixabel Soto
• Reynaldo Soto, LPTA
• Courtney Ann Soubliere, DO
• Allison Soukup, OTR
• Soul Alchemy LLC
• Soulcare Counseling
• Rebecca Soule, BT
• Source Medical Solutions
• James Southard, MD

• 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 Jul 8, 2007; 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.