Eastern Door Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801097205 Issued in MI

Legal business name

EASTERN DOOR COUNSELING, LLC

Practice address

800 Monroe Ave NW Ste 206
Grand Rapids, MI 49503-1448

Phone

(616) 802-0212

NPI assigned

Oct 22, 2017

Last updated

Oct 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole Fix, LMSWNPI 1669984100

Title

Member

Phone

(616) 802-0212

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Nicole Fix, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1669984100
  NPD Authorized official

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

{
    "created_epoch": "1508630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1891206447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 STRAWBERRY VALLEY AVE NW",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493219600",
            "telephone_number": "616-802-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MONROE AVE NW STE 206",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031448",
            "telephone_number": "616-802-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DOOR COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-22",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "FIX",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "616-802-0212",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jessica Easterbrook, PA-C
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• Andrew Eugene Eastham, LMSW
• Paige Eastlick
• Jacqueline Eastman Yam, MD

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, 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 Oct 6, 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.