Active NPI
Michelle G Vander Waal, PMHNP
- Mental Health Counselor
- Gearhart, OR
National Provider Identifier
1295906915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 200350142NP
- Practice address
- 3619 Highway 101 N
Gearhart, OR 97138-4321 - Phone
- (503) 738-3832
- Fax
- (503) 738-3466
- NPI assigned
- Mar 20, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 200350142NP | OR | Primary |
Addresses
Primary practice location
3619 Highway 101 N
Gearhart, OR 97138-4321
Mailing address
3619 Highway 101 N
Gearhart, OR 97138-4321
Phone (503) 738-3832
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 |
|---|---|---|---|
| 200350142NP | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205971200000",
"number": "1295906915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3619 HIGHWAY 101 N",
"city": "GEARHART",
"state": "OR",
"postal_code": "971384321",
"telephone_number": "503-738-3832",
"fax_number": "503-738-3466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3619 HIGHWAY 101 N",
"city": "GEARHART",
"state": "OR",
"postal_code": "971384321",
"telephone_number": "503-738-3832",
"fax_number": "503-738-3466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDER WAAL",
"first_name": "MICHELLE",
"middle_name": "G",
"credential": "PMHNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-20",
"last_updated": "2008-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "200350142NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gearhart, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.