Active NPI
T John Wilson, LBSW
- Social Worker
- Lapeer, MI
National Provider Identifier
1861589574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801073733
- Practice address
- 1570 Suncrest Dr
Lapeer, MI 48446-1154 - Phone
- (810) 667-0500
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801073733 | MI | Primary |
Addresses
Primary practice location
1570 Suncrest Dr
Lapeer, MI 48446-1154
Mailing address
10343 Oak Rd
Otisville, MI 48463-9768
Phone (810) 667-0500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1705242 TYPE21 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801073733 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440720000000",
"number": "1861589574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10343 OAK RD",
"city": "OTISVILLE",
"state": "MI",
"postal_code": "484639768",
"telephone_number": "810-667-0500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 SUNCREST DR",
"city": "LAPEER",
"state": "MI",
"postal_code": "484461154",
"telephone_number": "810-667-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "T",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "LBSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2015-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801073733",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1705242 TYPE21",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lapeer, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.