Kathleen Wakefield, LMSW-ACP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22205 Issued in TX

Practice address

2323 W Front St
Tyler, TX 75702-7704

Phone

(903) 597-1351

Fax

(903) 535-7384

NPI assigned

Mar 17, 2006

Last updated

Jan 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Andrew Center -Adt MH

  • Mental Illness Community Based Residential Treatment Facility
  • Tyler, TX
  • NPI 1891162871
  NPD (past)
• Andrews Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Canton, TX
  • NPI 1174547780
  NPD (past)
• Andrews Center

  • Developmental Disabilities Clinic/Center
  • Tyler, TX
  • NPI 1275592370
  NPD (past)
• Andrews Center

  • Clinic/Center
  • Tyler, TX
  • NPI 1922482751
  NPD (past)
• Andrews Center - Elliott St

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Canton, TX
  • NPI 1467900738
  NPD (past)
• Andrews Center - HCS

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Tyler, TX
  • NPI 1831269885
  NPD (past)
• Andrews Center - MH

  • Case Management Agency
  • Tyler, TX
  • NPI 1427119098
  NPD (past)
• Andrews Center - Mr

  • Case Manager/Care Coordinator
  • Tyler, TX
  • NPI 1093876252
  NPD (past)
• Andrews Center - TX Home Living

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Tyler, TX
  • NPI 1154491124
  NPD (past)
• Andrews Center-Adt

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Tyler, TX
  • NPI 1982070041
  NPD (past)
• Andrews Center-Autism

  • Child Intellectual and/or Developmental Disabilities Respite Care
  • Tyler, TX
  • NPI 1497089932
  NPD (past)
• Andrews Center-Chemical Dependancy

  • Substance Abuse Rehabilitation Facility
  • Tyler, TX
  • NPI 1851694186
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1063481380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4730",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757124730",
            "telephone_number": "903-535-7355",
            "fax_number": "903-535-7384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 W FRONT ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757027704",
            "telephone_number": "903-597-1351",
            "fax_number": "903-535-7384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKEFIELD",
        "first_name": "KATHLEEN",
        "credential": "LMSW-ACP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "22205",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "22205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169604901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Wagner, MD
• Gina L Wagner, PT
• Kelsey Wagner
• Demeshia Wagoner
• Lanna Waithe
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-1022)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-2688)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-1044)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-6467)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-5700)

• Clinical Social Worker in Tyler, TX
• Providers in Tyler, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.