Individual provider Active NPI

Jose Guillermo Parra, LLMSW

  • Social Worker
  • Pontiac, MI
National Provider Identifier
1639742208
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6851119916 Issued in MI
Practice address
1685 Baldwin Ave Ste 100
Pontiac, MI 48340-1242
Phone
(248) 706-3450
NPI assigned
Jul 21, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6851119916 MI Primary

Addresses

Primary practice location

1685 Baldwin Ave Ste 100
Pontiac, MI 48340-1242

Mailing address

11975 Townline Rd
Grand Blanc, MI 48439-1628
Phone (517) 614-4341

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
6851119916MIMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1639742208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11975 TOWNLINE RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484391628",
            "telephone_number": "517-614-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 BALDWIN AVE STE 100",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483401242",
            "telephone_number": "248-706-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARRA",
        "first_name": "JOSE",
        "middle_name": "GUILLERMO",
        "credential": "LLMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-21",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6851119916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; 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.