Active NPI
Michael Wilson, MA COUNSELING
- Mental Health Counselor
- Tigard, OR
National Provider Identifier
1013384379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- C5140
- Practice address
- 7110 SW Fir Loop Ste 220
Tigard, OR 97223 - Phone
- (503) 608-0796
- Fax
- (503) 213-5886
- NPI assigned
- Aug 21, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C5140 | OR | Primary |
Addresses
Primary practice location
7110 SW Fir Loop Ste 220
Tigard, OR 97223
Mailing address
7110 SW Fir Loop Ste 220
Tigard, OR 97223-8025
Phone (503) 608-0796
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 28, 2025 through May 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C5140 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549324800000",
"number": "1013384379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7110 SW FIR LOOP STE 220",
"city": "TIGARD",
"state": "OR",
"postal_code": "972238025",
"telephone_number": "503-608-0796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7110 SW FIR LOOP STE 220",
"city": "TIGARD",
"state": "OR",
"postal_code": "97223",
"telephone_number": "503-608-0796",
"fax_number": "503-213-5886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MICHAEL",
"credential": "MA COUNSELING",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-21",
"last_updated": "2019-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "C5140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.