Active NPI
Elizabeth Mbula Wasonga, LPC-S
- Professional Counselor
- Bethel, AK
National Provider Identifier
1215105762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 20115
- Practice address
- 828 Chief Eddie Hoffman Hwy
Bethel, AK 99559-0528 - Phone
- (907) 543-6100
- Fax
- (907) 543-6159
- NPI assigned
- Feb 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 20115 | TX | Primary |
Addresses
Primary practice location
828 Chief Eddie Hoffman Hwy
Bethel, AK 99559-0528
Mailing address
4102 Greenwood Way
Mansfield, TX 76063
Phone (682) 422-3909
Other practice location 1
4102 Greenwood Way
Mansfield, TX 76063
Phone (817) 999-4210
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020986 | Medicaid | AK | |
| 88601L | Other | TX | BLUECROSSBLUESHIELD PROV# |
| 193427501 | Medicaid | TX |
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 |
|---|---|---|---|
| 20115 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606780800000",
"number": "1215105762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4102 GREENWOOD WAY",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "76063",
"telephone_number": "682-422-3909",
"fax_number": "682-422-3909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 CHIEF EDDIE HOFFMAN HWY",
"city": "BETHEL",
"state": "AK",
"postal_code": "995590528",
"telephone_number": "907-543-6100",
"fax_number": "907-543-6159"
}
],
"practiceLocations": [
{
"address_1": "4102 Greenwood Way",
"address_purpose": "LOCATION",
"city": "Mansfield",
"state": "TX",
"postal_code": "76063",
"country_code": "US",
"telephone_number": "817-999-4210",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WASONGA",
"first_name": "ELIZABETH",
"middle_name": "MBULA",
"name_prefix": "Ms.",
"credential": "LPC-S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-19",
"last_updated": "2020-12-01",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "20115",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1020986",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD PROV#",
"identifier": "88601L",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "193427501",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.