Active NPI
Laurie Ann Theis
- Behavior Technician
- Grand Rapids, MI
National Provider Identifier
1720630403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 5250 Northland Dr NE
Grand Rapids, MI 49525-1096 - Phone
- (616) 361-5001
- NPI assigned
- Jul 12, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | |||
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
5250 Northland Dr NE
Grand Rapids, MI 49525-1096
Mailing address
5250 Northland Dr NE
Grand Rapids, MI 49525-1096
Phone (616) 361-5001
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747267200000",
"number": "1720630403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5250 NORTHLAND DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495251096",
"telephone_number": "616-361-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5250 NORTHLAND DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495251096",
"telephone_number": "616-361-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEIS",
"first_name": "LAURIE",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-12",
"last_updated": "2025-05-15",
"certification_date": "2025-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"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 May 15, 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.