Active NPI
Michael Wayne Wallington, LPCC
- Mental Health Counselor
- Espanola, NM
National Provider Identifier
1154477404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2331
- Practice address
- 904 E Fairview LN # B
Espanola, NM 87532-2822 - Phone
- (505) 747-1991
- Fax
- (505) 753-6462
- NPI assigned
- Jan 26, 2007
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2331 | NM | Primary |
Addresses
Primary practice location
904 E Fairview LN # B
Espanola, NM 87532-2822
Mailing address
PO Box KK
Taos, NM 87571-1570
Phone (505) 751-7037
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 |
|---|---|---|---|
| 2331 | NM | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154477404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX KK",
"city": "TAOS",
"state": "NM",
"postal_code": "875711570",
"telephone_number": "505-751-7037",
"fax_number": "505-751-3010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 E FAIRVIEW LN # B",
"city": "ESPANOLA",
"state": "NM",
"postal_code": "875322822",
"telephone_number": "505-747-1991",
"fax_number": "505-753-6462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLINGTON",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": "2331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Espanola, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.