Michael E Waldon, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

S30270 Issued in TX

Practice address

3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277

Phone

(817) 569-4396

Fax

(817) 569-4517

NPI assigned

Dec 18, 2006

Last updated

Jul 14, 2014By the provider in NPPES

Sex

Male

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1205999604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2603",
            "address_2": "HTN, CLIENT ACCOUNTING",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761132603",
            "telephone_number": "817-569-4396",
            "fax_number": "817-569-4517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 HULEN ST",
            "address_2": "HTN, CLIENT ACCOUNTING",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077277",
            "telephone_number": "817-569-4396",
            "fax_number": "817-569-4517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDON",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "S30270",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "S30270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040213302",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040213301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "89640Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores Texas, LP (Vision Center 30-0590)
• Wal-Mart Stores Texas, LP (Vision Center 30-1455)
• Wal-Mart Stores, Texas, LLC (Wal-Mart Vision Center 30-3773)
• Lauren Walden, M.D.
• Angela B Waldern, OTR
• Amy Waldrip-Miranda, SLP
• Kerri A Waldron, MD
• Leah Marie Waldron, RBT
• David Waldrop
• Walgreen

• Clinical Social Worker in Fort Worth, TX
• Providers in Fort Worth, 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 Jul 14, 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.