Individual provider Active NPI

Robert Tom Rollis III, LPC

  • Professional Counselor
  • Lansing, MI
National Provider Identifier
1710158308
Registry record updated Feb 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401018728 Issued in MI
Practice address
4136 Legacy Pkwy
Lansing, MI 48911-4265
Phone
(928) 771-3544
NPI assigned
Mar 21, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 12618 AZ
Professional Counselor 101YP2500X 6401018728 MI Primary

Addresses

Primary practice location

4136 Legacy Pkwy
Lansing, MI 48911-4265

Mailing address

2301 Meadowcroft Dr
Lansing, MI 48912-3517
Phone (928) 830-2575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231128000648 MI Practitioner - Mental Health Counselor 9739537044 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kairos Counseling and WellnessGroup PAC ID 5395112247, 3 clinicians
Downriver Mental Health Clinic PCGroup PAC ID 7911995139, 289 clinicians

Practice addresses (Care Compare)

12800 Escanaba Dr
Suite D
Dewitt, MI 48820-8680
Phone (517) 449-4162

1400 Abbot Rd
Suite 400
East Lansing, MI 48823-1900
Phone (517) 882-3732

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12618AZMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Downriver Mental Health Clinic PC Professional CurrentSince Jan 1, 2024 Accepting new patients
Kairos Counseling and Wellness CurrentSince Oct 8, 2025 Accepting new patients
Downriver Mental Health Clinic PC CurrentSince Jan 1, 2024 Accepting new patients

Locations

12800 Escanaba Dr
Ste D
Dewitt, MI 48820
Phone (517) 449-4162

1400 Abbot Rd
Ste 400
East Lansing, MI 48823
Phone (810) 220-2787

4136 Legacy Pkwy
Lansing, MI 48911
Phone (517) 492-0517

1701 Lake Lansing Rd
Ste 120
Lansing, MI 48912
Phone 8104947180 ext. 106

Organizations & group practices 3

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": "1206057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645228800000",
    "number": "1710158308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 MEADOWCROFT DR",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489123517",
            "telephone_number": "928-830-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4136 LEGACY PKWY",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489114265",
            "telephone_number": "928-771-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLIS",
        "first_name": "ROBERT",
        "middle_name": "TOM",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-21",
        "last_updated": "2022-02-19",
        "certification_date": "2022-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "12618",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401018728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.