Mattracea Wendleton, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

2017037738 Issued in MO

Practice address

900 E San Martin St
Bolivar, MO 65613-2893

Phone

(417) 501-9722

NPI assigned

Oct 29, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mattracea Warren Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1376948679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 E SAN MARTIN ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132893",
            "telephone_number": "417-501-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E SAN MARTIN ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132893",
            "telephone_number": "417-501-9722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3520 S Springfield Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Bolivar",
            "state": "MO",
            "postal_code": "656139112",
            "country_code": "US",
            "telephone_number": "417-501-9722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENDLETON",
        "first_name": "MATTRACEA",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2017037738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MATTRACEA",
            "last_name": "WARREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Edward Walkup, LCSW
• Kelly M Watson, FNP
• Kristi June Webb, LPC
• Mariah Wellman
• Wellness Connection Inc
• Timothy Eugene West, PHARM.D
• Amy Westerman, COTA/L
• Pamela Wharton, LPC
• Sno White-Benson, RPH, PHARM D.
• Kelley White

• Counselor in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; 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.