Tara Henderson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801117772 Issued in MI

Practice address

3300 36TH St SE
Grand Rapids, MI 49512-2810

Phone

(616) 942-2110

NPI assigned

Dec 8, 2020

Last updated

Jun 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tara Pummell Former name

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tara.pummell.p1@direct.isabellahealth.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Isabella Citizens for Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mt Pleasant, MI
  • NPI 1104177195
  Medicare reassignment NPD
• Isabella Citizens for Health Inc

  dba Farwell Health Center of Isabella Citizens for Health Inc

  • Federally Qualified Health Center (FQHC)
  • Farwell, MI
  • NPI 1548090491
  NPD
• Isabella Citizens for Health Inc

  dba Health Park Pharmacy

  • Community/Retail Pharmacy
  • Mt Pleasant, MI
  • NPI 1942842471
  NPD
• Virtuwell Therapy, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1871356212
  NPD (past)

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

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1952907685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 36TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122810",
            "telephone_number": "616-942-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 36TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122810",
            "telephone_number": "616-942-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-08",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801117772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "PUMMELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leeshay Henderson
• Michael A Henderson, DO
• Quartus Henderson
• Scott J Henderson, PT
• Shanna Henderson
• Zachary Henderson, LMSW
• Devin Hendges
• Ryien Hendrick
• Scot Wray Hendrick, DO
• Alesha Rene' Hendricks

• 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 Jun 27, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.