Individual provider Active NPI

William Zane Zogg, MA

  • Mental Health Counselor
  • University Place, WA
National Provider Identifier
1043789530
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LH61050187 Issued in WA
Practice address
4113 Bridgeport Way W Ste C1
University Place, WA 98466-4325
Phone
(509) 290-7809
NPI assigned
Nov 14, 2018
Reactivated
Sep 23, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LH61050187 WA Primary

Addresses

Primary practice location

4113 Bridgeport Way W Ste C1
University Place, WA 98466-4325

Mailing address

4113 Bridgeport Way W Ste C1
University Place, WA 98466-4325
Phone (509) 290-7809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20260521004449 WA Practitioner - Mental Health Counselor 2961972716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1400 Broadway
Bellingham, WA 98225-3036

6158 Lincoln Dr
Ferndale, WA 98248-8787

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LH61050187WAMDMental Health Counselor

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1043789530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4113 BRIDGEPORT WAY W STE C1",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664325",
            "telephone_number": "509-290-7809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4113 BRIDGEPORT WAY W STE C1",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664325",
            "telephone_number": "509-290-7809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZOGG",
        "first_name": "WILLIAM",
        "middle_name": "ZANE",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-14",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "deactivation_date": "2022-08-29",
        "reactivation_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61050187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

Verify at the official NPI Registry.