Individual provider Active NPI

Donald Son Murry, LSWAIC

  • Mental Health Counselor
  • Vancouver, WA
National Provider Identifier
1215406566
Registry record updated Nov 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
SC60815401 Issued in WA
Practice address
1601 E 4TH Plain Blvd Ste a-152
Vancouver, WA 98661-3713
Phone
(360) 397-8198
Fax
(360) 398-8476
NPI assigned
Nov 15, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X SC60815401 WA Primary

Addresses

Primary practice location

1601 E 4TH Plain Blvd Ste a-152
Vancouver, WA 98661-3713

Mailing address

PO Box 5000
Vancouver, WA 98666-5000
Phone (360) 397-8198

Other identifiers 1

IdentifierTypeStateIssuer
1699916114MedicaidWA

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

LicenseStateTypeSpecialty
SC60815401WAMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542240000000",
    "number": "1215406566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5000",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986665000",
            "telephone_number": "360-397-8198",
            "fax_number": "360-397-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E 4TH PLAIN BLVD STE A-152",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613713",
            "telephone_number": "360-397-8198",
            "fax_number": "360-398-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MURRY",
        "first_name": "DONALD",
        "middle_name": "SON",
        "credential": "LSWAIC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-15",
        "last_updated": "2018-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "SC60815401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699916114",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; 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.