NPIMap

Organization Active NPI

Willapa Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Long Beach, WA
National Provider Identifier
1174570949
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
J600618510 Issued in WA
Legal business name
WILLAPA COUNSELING CENTER
Practice address
2204 Pacific Ave N
Long Beach, WA 98631-3300
Phone
(360) 642-3787
Fax
(360) 642-2096
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Authorized official

Name
Lindsey MatzenNPI 1598183436
Title
Provider Enrollment
Phone
(360) 642-3783

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X J600618510 WA Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

2204 Pacific Ave N
Long Beach, WA 98631-3300

Mailing address

2204 Pacific Ave N
Long Beach, WA 98631-3300
Phone (360) 642-3787

Other practice location 1

300 Ocean Ave
Raymond, WA 98577-3016
Phone (360) 942-2303

Other practice location 2

25902 Ocean Beach HWY, Suite B
Ocean Park, WA 98640
Phone (360) 642-3787

Other practice location 3

338 W Pioneer Ave
Montesano, WA 98563-4412
Phone (360) 942-2303

Other practice location 4

2601 Pacific Ave N
Long Beach, WA 98631-3864
Phone (360) 642-3787

Other identifiers 1

IdentifierTypeStateIssuer
1054667MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308001221 WA Part B Supplier - Clinic/Group Practice 4587552831 Receives reassigned benefits from 20 practitioners
Practice locations: Montesano, WA; Raymond, WA; Long Beach, WA

National Provider Directory

National Provider Directory

Locations

2204 Pacific Ave N
Long Beach, WA 98631
Phone (360) 642-3787

1107 Pacific Ave N
Long Beach, WA 98631
Phone (360) 642-3787

1107 Pacific Ave N
Long Beach, WA 98631

2601 Pacific Ave N
Long Beach, WA 98631
Phone (360) 642-3787

338 W Pioneer Ave
Montesano, WA 98563
Phone (360) 515-7342

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1174570949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 PACIFIC AVE N",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "986313300",
            "telephone_number": "360-642-3787",
            "fax_number": "360-642-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 PACIFIC AVE N",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "986313300",
            "telephone_number": "360-642-3787",
            "fax_number": "360-642-2096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Ocean Ave",
            "address_purpose": "LOCATION",
            "city": "Raymond",
            "state": "WA",
            "postal_code": "985773016",
            "country_code": "US",
            "telephone_number": "360-942-2303",
            "fax_number": "360-942-5312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25902 Ocean Beach HWY, Suite B",
            "address_purpose": "LOCATION",
            "city": "Ocean Park",
            "state": "WA",
            "postal_code": "98640",
            "country_code": "US",
            "telephone_number": "360-642-3787",
            "fax_number": "360-942-5312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "338 W Pioneer Ave",
            "address_purpose": "LOCATION",
            "city": "Montesano",
            "state": "WA",
            "postal_code": "985634412",
            "country_code": "US",
            "telephone_number": "360-942-2303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 Pacific Ave N",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "WA",
            "postal_code": "986313864",
            "country_code": "US",
            "telephone_number": "360-642-3787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILLAPA COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "MATZEN",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "360-642-3783"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WA",
            "license": "J600618510",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1054667",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.