LINDSEY AUTUMN DISTEFANO MA
NPI 1174020291
Counselor - Professional in Grand Rapids, MI

Q: What is Lindsey Distefano's NPI number?

The NPI number for Lindsey Distefano is 1174020291. It was assigned to this individual provider in the NPPES registry on April 6, 2018.

Q: What is Lindsey Distefano's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Lindsey Distefano was last updated on August 24, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 06, 2018PECOS Enrolled

1000 MONROE AVE NW, GRAND RAPIDS, MI 49503(616) 259-7207(616) 259-7261 Get Directions Write a Review

NPPES record last updated: August 24, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 24, 2023, Jul 17, 2023, May 14, 2020 (3 updates tracked since 2020).

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About Lindsey Autumn Distefano Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LINDSEY AUTUMN DISTEFANO MA (NPI 1174020291) is an individual professional provider in Grand Rapids, Michigan, licensed in Michigan (6401223229) and active in the NPI registry since April 2018. She is enrolled in Medicare PECOS, maintains a secondary practice location in Centennial, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1174020291

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameLINDSEY AUTUMN DISTEFANOCredential: MA

Location Address1000 MONROE AVE NWGrand Rapids, MI 49503-1455

Mailing Address1000 Monroe Ave NwGrand Rapids, MI 49503-1455 · (616) 259-2707

Phone(616) 259-7207

Fax(616) 259-7261

Sole ProprietorYes

Medical School CMSOtherGraduated 2017

Enumeration DateApril 6, 2018

Last NPPES UpdateAugust 24, 20233 updates tracked since enumeration

NPPES CertifiedAugust 24, 2023

✔ NPI 1174020291 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in MI · 6401223229

Also ListedCounselorTaxonomy 101Y00000X · License LPCC0015902 (CO)

Also ListedCounselor · SchoolTaxonomy 101YS0200X · License LPCC0015902 (CO)

1000 MONROE AVE NW, Grand Rapids, MI 49503

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Secondary Practice Location 1

Location 112835 E Arapahoe Rd Ste 400Centennial, CO 80112-3940 · Phone (303) 954-9809

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lindsey Autumn Distefano Ma is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2668948621

PECOS Enrollment IDI20260416003412

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TIMOTHY JAMES FIFE DO

Internal Medicine (Hospice and Palliative Medicine)