Individual provider Active NPI

Nicole Fix, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1669984100
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801097205 Issued in MI
Practice address
800 Monroe Ave NW Ste 206
Grand Rapids, MI 49503-1448
Phone
(616) 802-0212
NPI assigned
Oct 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801097205 MI Primary

Addresses

Primary practice location

800 Monroe Ave NW Ste 206
Grand Rapids, MI 49503-1448

Mailing address

792 Strawberry Valley Ave NW
Comstock Park, MI 49321-9600
Phone (616) 802-0212

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
6801097205MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Door Counseling, LLC Clinical Current Accepting new patients

Locations

800 Monroe Ave NW
Ste 206
Grand Rapids, MI 49503
Phone (616) 206-4499

3501 Lake Eastbrook Blvd SE
Ste 345
Grand Rapids, MI 49546
Phone (602) 301-1378

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1669984100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 STRAWBERRY VALLEY AVE NW",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493219600",
            "telephone_number": "616-802-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MONROE AVE NW STE 206",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031448",
            "telephone_number": "616-802-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIX",
        "first_name": "NICOLE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-24",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.