Active NPI
Abbey Mix
- Behavior Analyst
- Grand Rapids, MI
National Provider Identifier
1699363101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 7401000506
- Practice address
- 4434 Heather LN SE
Grand Rapids, MI 49546-2350 - Phone
- (616) 916-6838
- NPI assigned
- Jan 10, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801090284 | MI | |
| Behavior Analyst | 103K00000X | 7401000506 | MI | Primary |
Addresses
Primary practice location
4434 Heather LN SE
Grand Rapids, MI 49546-2350
Mailing address
4434 Heather LN SE
Grand Rapids, MI 49546-2350
Phone (616) 916-6838
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 |
|---|---|---|---|
| 7401000506 | MI | MD | Behavioral Analyst |
| 6801090284 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610236800000",
"number": "1699363101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4434 HEATHER LN SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462350",
"telephone_number": "616-916-6838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4434 HEATHER LN SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462350",
"telephone_number": "616-916-6838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIX",
"first_name": "ABBEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-10",
"last_updated": "2021-01-10",
"certification_date": "2021-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801090284",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": "7401000506",
"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 Jan 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.