Individual provider Active NPI

Julie E Gallivan

  • Professional Counselor
  • Grant, MI
National Provider Identifier
1780160283
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401016694 Issued in MI
Practice address
11 N Maple St
Grant, MI 49327-7900
Phone
(231) 834-0444
Fax
(231) 834-0200
NPI assigned
Jul 17, 2018
Last updated
May 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401016694 MI Primary

Addresses

Primary practice location

11 N Maple St
Grant, MI 49327-7900

Mailing address

194 Brown Rd
Bailey, MI 49303-9782
Phone (616) 432-7551

Other practice location 1

5242 Plainfield Ave NE Ste E
Grand Rapids, MI 49525-1084
Phone (616) 432-7551

Other practice location 2

96 E 120th St
Grant, MI 49327-8502
Phone (231) 834-1350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401016694MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
West Michigan Psychological Services LLC CurrentSince Feb 14, 2024 Accepting new patients
Baldwin Family Health Care Past Accepting new patients

Locations

1475 Robbins Rd
Ste 150
Grand Haven, MI 49417
Phone (616) 315-9605

259 Hoover Blvd
Ste 140
Holland, MI 49423
Phone (616) 460-0174

400 136th Ave
Ste 416
Holland, MI 49424
Phone (616) 738-0470

890 Washington Ave
Ste 150
Holland, MI 49423
Phone (616) 952-9957

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1780160283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 BROWN RD",
            "city": "BAILEY",
            "state": "MI",
            "postal_code": "493039782",
            "telephone_number": "616-432-7551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 N MAPLE ST",
            "city": "GRANT",
            "state": "MI",
            "postal_code": "493277900",
            "telephone_number": "231-834-0444",
            "fax_number": "231-834-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5242 Plainfield Ave NE Ste E",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495251084",
            "country_code": "US",
            "telephone_number": "616-432-7551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "96 E 120th St",
            "address_purpose": "LOCATION",
            "city": "Grant",
            "state": "MI",
            "postal_code": "493278502",
            "country_code": "US",
            "telephone_number": "231-834-1350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLIVAN",
        "first_name": "JULIE",
        "middle_name": "E",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-17",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401016694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grant, MI

Sources for this page

Verify at the official NPI Registry.