Constance Averill, PH.D, LMSW, ACSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801082009 Issued in MI

Practice address

4020 Copper VW Ste 104
Traverse City, MI 49684-7041

Phone

(231) 421-6921

Fax

(231) 421-7852

NPI assigned

Feb 5, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Clinical Social Worker

Education

University of New Mexico School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brightside Medical of Michigan PCGroup PAC ID 9830562776, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Brightside Medical of Michigan PC

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1144800350

  MI

  Medicare reassignment Care Compare group NPD
• Chronic Care Management LLC

  • Family Medicine Physician
  • Traverse City, MI
  • NPI 1730506726

  Social Worker

  Medicare reassignment NPD
• Illuminate My Life Counseling

  • Clinical Social Worker
  • Traverse City, MI
  • NPI 1902570591
  NPD (past)

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1831338441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3785 BAY RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032433",
            "telephone_number": "989-791-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 COPPER VW STE 104",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847041",
            "telephone_number": "231-421-6921",
            "fax_number": "231-421-7852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9618 Pennintgon",
            "address_purpose": "LOCATION",
            "city": "Interlochen",
            "state": "MI",
            "postal_code": "49643",
            "country_code": "US",
            "telephone_number": "231-360-0699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVERILL",
        "first_name": "CONSTANCE",
        "name_prefix": "Dr.",
        "credential": "PH.D,  LMSW, ACSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-05",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "L877869",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801082009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccm@chronic-care.net",
            "affiliation": "N",
            "endpointDescription": "Chronic Care e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "e-mail",
            "address_1": "4020 Copper Vw Ste 104",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496847041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kyrsten Austin, MS, RD
• Paula Jean Austin, MA, CCC-SLP
• William A Austin, M.D.
• Authentic Life Counseling and Wellness, PLLC
• Autism Center of Northern Michigan
• Ann M Avery, NURSE PRACTITIONER
• Ashley Avery
• Bianca Avolio
• Joel Thomas Ayala, OTR
• Melissa Aylworth, DDS

• Clinical Social Worker in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.