139 EDUCATION, LLC. (NPI# 1013294628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013294628 |
| Entity Type | Organization |
| Organization Name | 139 EDUCATION, LLC. |
| Other Organization Name | NEUROCORE |
| Practice Address |
3148 44th St Sw Grandville MI 49418 |
| Mailing Address |
201 Monroe Ave Nw Suite 300 Grand Rapids MI 49503 |
| Practice Telephone | 8006004096 |
| Practice Fax Number | 8006068839 |
| Mailing Telephone | 8006004096 |
| Mailing Fax Number | 8006068839 |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2017-02-21 |
| Authorized Official Name | TIMOTHY ROYER (PROVIDER/AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 8006004096 |
| Authorized Official Credential | PSY |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 6301009353 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | 0D14689 | 01 |
| Other Name | Type Code |
|---|---|
| Neurocore | Doing Business As Name - Organization |
| Street Address |
3148 44TH ST SW |
| City | GRANDVILLE |
| State | MI |
| Zip Code | 49418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841653847 | Rachel Elizabeth Martin | Social Worker | 3148 44th St Sw, Grandville, MI 49418-2567 | 2016-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144799669 | Holly Cieslinski | Occupational Therapist | 3550 Fairlines Ave, Grandville, MI 49418 | 2018-11-14 |
| 1639664857 | Athletico Ltd | Physical Therapist | 3819 Rivertown Pkwy Sw Ste 100, Grandville, MI 49418 | 2018-06-29 |
| 1437651916 | Great Lakes Wellness Counseling LLC | Counselor | 2900 Wilson Ave Suite 110, Grandville, MI 49418 | 2018-03-01 |
| 1780111765 | Jenna Sargent | Nurse Practitioner | 2845 44th St Sw, Ste 200, Grandville, MI 49418 | 2017-05-22 |
| 1881132827 | Laura Elizabeth Ramaker | Specialist/Technologist | 2787 Pine Dunes Ct Sw, Wyoming, MI 49418 | 2017-02-10 |
| 1689026130 | Charles Unseld | Hearing Instrument Specialist | O-38 44th St Sw, Grandville, MI 49418 | 2016-07-08 |
| 1972989655 | Laci Dawn Johncock | Physical Therapy Assistant | 2786 56th Street, Wyoming, MI 49418 | 2015-08-05 |
| 1891178570 | Joshua Kolman | Pharmacist | 3434 Century Center Dr Sw, Grandville, MI 49418 | 2015-06-30 |
| 1710368782 | Tracie Medrano- Smith | Family Medicine | 4174 56th St Sw, Wyoming, MI 49418 | 2015-06-15 |
| 1124410808 | Kim Michelle Childress | Counselor | 4565 Wilson Ave Sw Ste 3a, Grandville, MI 49418 | 2015-03-04 |
| Find all providers in zip 49418 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295044451 | Jennifer Bauer | Psychologist | 3790 30th St Se, Grandville, MI 49418-1201 | 2010-10-05 |
| 1487669289 | Leslie Robin Visser | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-07-30 |
| 1407141476 | Evonne M Edwards | Psychologist | 4211 Parkway Pl Sw, Grandville, MI 49418-2695 | 2011-06-17 |
| 1720282668 | Steven James Runner | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2007-06-13 |
| 1891813994 | James Robert Grooters | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2007-03-27 |
| 1992842777 | Richard Louis Allers | Psychologist | 4320 44th St Sw, Suite 103, Grandville, MI 49418-2300 | 2007-01-31 |
| 1770651283 | Kevin Carl Elmore | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-12-01 |
| 1275544413 | Pine Rest Christian Mental Health Services | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-08-11 |
| 1184632846 | Jamie Leigh Wieber | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-08-04 |
| 1912915653 | Jon Karl Wierenga | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-08-04 |
| Find all providers in GRANDVILLE | ||||
| City | GRANDVILLE |
| Zip Code | 49418 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.