Active NPI
Kevin Daniel Vaillancourt, LLPC
- Professional Counselor
- Big Rapids, MI
National Provider Identifier
1699128439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401015505
- Practice address
- 15495 Old Millpond Rd
Big Rapids, MI 49307-9502 - Phone
- (231) 796-9188
- NPI assigned
- Jul 17, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401015505 | MI | Primary |
Addresses
Primary practice location
15495 Old Millpond Rd
Big Rapids, MI 49307-9502
Mailing address
1004 S Anna St
Mt Pleasant, MI 48858-3602
Phone (989) 944-3589
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6401015505 | MI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverview Counseling and Wellness Center, P.C. | Past | Accepting new patients | |
| Life Guidance Services | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Social Worker
- Grand Rapids, MI
- NPI 1336185032
-
- Psychologist
- Big Rapids, MI
- NPI 1093945636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468713600000",
"number": "1699128439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 S ANNA ST",
"city": "MT PLEASANT",
"state": "MI",
"postal_code": "488583602",
"telephone_number": "989-944-3589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15495 OLD MILLPOND RD",
"city": "BIG RAPIDS",
"state": "MI",
"postal_code": "493079502",
"telephone_number": "231-796-9188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAILLANCOURT",
"first_name": "KEVIN",
"middle_name": "DANIEL",
"credential": "LLPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-17",
"last_updated": "2016-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401015505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Big Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.