Polly Ann McCaul, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6451017485 Issued in MI

Practice address

3744 28TH St SE
Kentwood, MI 49512-1802

Phone

(800) 395-3223

Fax

(248) 620-6405

NPI assigned

Sep 16, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Polly Ann French Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Divine Mind Counseling and Consulting Services

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1013523976
  NPD (past)

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1790455293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6549 TOWN CENTER DR STE A",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483464824",
            "telephone_number": "800-395-3223",
            "fax_number": "248-620-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3744 28TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495121802",
            "telephone_number": "800-395-3223",
            "fax_number": "248-620-6405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3777 44th St SE Ste 2",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495123945",
            "country_code": "US",
            "telephone_number": "616-209-9192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCAUL",
        "first_name": "POLLY",
        "middle_name": "ANN",
        "credential": "LLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-16",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401017485",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6451017485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "polly@harmonygr.com",
            "affiliation": "N",
            "endpointDescription": "Business email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Lowell",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Correspondence",
            "address_1": "3777 44th St SE Ste 2",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495123945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "POLLY",
            "last_name": "FRENCH",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelsey Matthews
• Tammy Matvichuk
• David Edward May, D.D.S
• Grace Mayes
• Jacob Jeffery McBride, DC
• Ebony Monique McCauley
• Dakota McCaw
• Ronald T McClatchey, OD
• McColley Speech Services PLC
• Brandon Michael McColley, SLP

• Professional Counselor in Kentwood, MI
• Providers in Kentwood, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.