Elizabeth A Pellegrom, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401008238 Issued in MI

Practice address

18565 Woodduck Dr
Spring Lake, MI 49456-2901

Phone

(269) 744-2604

NPI assigned

Jun 1, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Blue Mind Wellness, LLC

  • Professional Counselor
  • Spring Lake, MI
  • NPI 1467138115
  NPD Authorized official

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

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1871232652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18565 WOODDUCK DR",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494562901",
            "telephone_number": "269-744-2604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18565 WOODDUCK DR",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494562901",
            "telephone_number": "269-744-2604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "131 W Seaway Dr",
            "address_purpose": "LOCATION",
            "city": "Norton Shores",
            "state": "MI",
            "postal_code": "494443759",
            "country_code": "US",
            "telephone_number": "806-523-1375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLEGROM",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401008238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Spring Lake, MI
• Providers in Spring Lake, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.