Active NPI
Michael Gene Waldrip
- Professional Counselor
- Terrytown, LA
National Provider Identifier
1023664372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5590
- Practice address
- 1799 Stumpf Blvd.
Building 3, Suite 2
Terrytown, LA 70056-7005 - Phone
- (504) 255-4205
- NPI assigned
- Aug 13, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5590 | LA | Primary |
Addresses
Primary practice location
1799 Stumpf Blvd.
Building 3, Suite 2
Terrytown, LA 70056-7005
Mailing address
3715 Lake Villa Dr
Metairie, LA 70002-4331
Phone (504) 255-4205
Other practice location 1
1799 Stumpf Blvd
Terrytown, LA 70056-3950
Phone (504) 255-4205
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Terrytown | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5590 | LA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565654400000",
"number": "1023664372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3715 LAKE VILLA DR",
"city": "METAIRIE",
"state": "LA",
"postal_code": "700024331",
"telephone_number": "504-255-4205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1799 STUMPF BLVD.",
"address_2": "BUILDING 3, SUITE 2",
"city": "TERRYTOWN",
"state": "LA",
"postal_code": "700567005",
"telephone_number": "504-255-4205"
}
],
"practiceLocations": [
{
"address_1": "1799 Stumpf Blvd",
"address_purpose": "LOCATION",
"city": "Terrytown",
"state": "LA",
"postal_code": "700563950",
"country_code": "US",
"telephone_number": "504-255-4205",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALDRIP",
"first_name": "MICHAEL",
"middle_name": "GENE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-13",
"last_updated": "2019-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "5590",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Terrytown",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Terrytown",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Terrytown",
"address_1": "1799 Stumpf Blvd.",
"address_2": "Building 3, Suite 2",
"city": "Terrytown",
"state": "LA",
"country_code": "US",
"postal_code": "700567005",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Terrytown, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.