NPIMap

Organization Active NPI

Trio Wellspace, LLC

  • Clinical Social Worker
  • Holland, MI
National Provider Identifier
1831859826
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
TRIO WELLSPACE, LLC
Practice address
486 Century LN
Holland, MI 49423-4295
Phone
(616) 886-1265
NPI assigned
Dec 18, 2021
Last updated
Dec 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Authorized official

Name
Molly Henson-Boone, LMSWNPI 1588064372
Title
Co-Owner
Phone
(616) 298-2731

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

486 Century LN
Holland, MI 49423-4295

Mailing address

486 Century LN
Holland, MI 49423-4295
Phone (616) 298-2731

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220728002897 MI Part B Supplier - Clinic/Group Practice 5092197699 Receives reassigned benefits from 4 practitioners
Practice locations: Holland, MI

National Provider Directory

National Provider Directory

Locations

486 Century Ln
Holland, MI 49423
Phone (616) 298-2731

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1639785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1831859826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 CENTURY LN",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234295",
            "telephone_number": "616-298-2731",
            "fax_number": "616-298-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 CENTURY LN",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234295",
            "telephone_number": "616-886-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIO WELLSPACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-18",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "HENSON-BOONE",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "616-298-2731",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.