NPIMap

Organization Active NPI

Jennifer Bazner, Ma, LPC LLC

  • Mental Health Counselor
  • Grand Rapids, MI
National Provider Identifier
1750943262
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
JENNIFER BAZNER, MA, LPC LLC
Practice address
4829 E Beltline Ave NE BLDG 1
Grand Rapids, MI 49525-9747
Phone
(616) 446-1117
NPI assigned
Jul 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Authorized official

Name
Jennifer L Bazner, LPCNPI 1417134453
Title
Therapist/Owner
Phone
(616) 446-1117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4829 E Beltline Ave NE BLDG 1
Grand Rapids, MI 49525-9747

Mailing address

4829 E Beltline Ave NE BLDG 1
Grand Rapids, MI 49525-9747
Phone (616) 446-1117

Other identifiers 1

IdentifierTypeStateIssuer
1417134453MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL simplepractice.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562112000000",
    "number": "1750943262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4829 E BELTLINE AVE NE BLDG 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259747",
            "telephone_number": "616-446-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4829 E BELTLINE AVE NE BLDG 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259747",
            "telephone_number": "616-446-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER BAZNER, MA, LPC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-03",
        "last_updated": "2019-07-03",
        "status": "A",
        "authorized_official_last_name": "BAZNER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "THERAPIST/OWNER",
        "authorized_official_telephone_number": "616-446-1117",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417134453",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "4829 E Beltline Ave NE Bldg 1",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495259747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Jul 3, 2019; 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.