Individual provider Active NPI

Matilda Sampson

  • Counselor
  • Spokane, WA
National Provider Identifier
1104239813
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
SC60344704 Issued in WA
Practice address
1803 W Maxwell Ave
Spokane, WA 99201-2831
Phone
(509) 483-7535
Fax
(509) 482-2794
NPI assigned
Jun 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X SC60344704 WA Primary
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

1803 W Maxwell Ave
Spokane, WA 99201-2831

Mailing address

1803 W Maxwell Ave
Spokane, WA 99201-2831
Phone (509) 483-7535

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

LicenseStateTypeSpecialty
SC60344704WAMDCounselor

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1104239813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 W MAXWELL AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992012831",
            "telephone_number": "509-483-7535",
            "fax_number": "509-482-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 W MAXWELL AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992012831",
            "telephone_number": "509-483-7535",
            "fax_number": "509-482-2794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "MATILDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "SC60344704",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.