Jeff Wilson, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60391036 Issued in WA

Practice address

611 W Cota St
Shelton, WA 98584-2241

Phone

(360) 426-5654

Fax

(360) 426-5641

NPI assigned

Aug 6, 2015

Last updated

Aug 6, 2015By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Social Treatment Opportunity Programs II, Inc

  dba STOP Shelton

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shelton, WA
  • NPI 1497080931
  NPD (past)

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

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438819200000",
    "number": "1235515776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W COTA ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842241",
            "telephone_number": "360-426-5654",
            "fax_number": "360-426-5641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W COTA ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842241",
            "telephone_number": "360-426-5654",
            "fax_number": "360-426-5641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFF",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-06",
        "last_updated": "2015-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60391036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashely L Wihley, LMP
• Owen Wilder
• Michelle Louise Wiley, RDH
• William J Busacca DDS, PS
• Faith Williams, CD
• Jonathan Corbin Wilton, M.D.
• Haley Kai Wood
• Morgan Wood
• Phil Woodard, PHARM.D
• Cheryl Woods, PT

• Addiction (Substance Use Disorder) Counselor in Shelton, WA
• Providers in Shelton, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; 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.