NPIMap

Individual provider Active NPI

Benjamin Theodore Descoteaux, M.ED.

  • Mental Health Counselor
  • Omak, WA
National Provider Identifier
1255440376
Registry record updated Nov 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LH00009254 Issued in WA
Practice address
1007 Koala Ave
Omak, WA 98841-9247
Phone
(509) 826-6191
Fax
(509) 826-8560
NPI assigned
Aug 30, 2006
Last updated
Nov 11, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X RC00030840 WA
Addiction (Substance Use Disorder) Counselor 101YA0400X CP00001300 WA
Mental Health Counselor 101YM0800X LH00009254 WA Primary

Addresses

Primary practice location

1007 Koala Ave
Omak, WA 98841-9247

Mailing address

1007 Koala Ave
Omak, WA 98841-9247
Phone (509) 826-6191

Other identifiers 1

IdentifierTypeStateIssuer
1980812MedicaidWA

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
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
RC00030840WAMDCounselor
CP00001300WAMDAddiction (Substance Use Disorder) Counselor
LH00009254WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Okanogan Behavioral Healthcare Past Accepting new patients
Colville Nation Community Health Centers Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226361600000",
    "number": "1255440376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 KOALA AVE",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419247",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 KOALA AVE",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419247",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESCOTEAUX",
        "first_name": "BENJAMIN",
        "middle_name": "THEODORE",
        "name_prefix": "Mr.",
        "credential": "M.ED.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "RC00030840",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00001300",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00009254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1980812",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; 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.