Michael Dwayne Roos, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LF 60497884 Issued in WA

Practice address

719 Sleater Kinney Rd SE Ste 212
Lacey, WA 98503-1138

Phone

(360) 519-4256

NPI assigned

Dec 18, 2009

Last updated

Nov 22, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511308800000",
    "number": "1215266309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 SLEATER KINNEY RD SE STE 212",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031138",
            "telephone_number": "360-519-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 SLEATER KINNEY RD SE STE 212",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031138",
            "telephone_number": "360-519-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOS",
        "first_name": "MICHAEL",
        "middle_name": "DWAYNE",
        "name_prefix": "Mr.",
        "credential": "MA, LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-18",
        "last_updated": "2017-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF 60497884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2069009",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Lacey, WA
• Providers in Lacey, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2017; 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.