Mystic Mountain Midwifery, LLC.

Primary specialty

MidwifeTaxonomy code 176B00000X

Legal business name

MYSTIC MOUNTAIN MIDWIFERY, LLC.

Practice address

207 Center Street E
Eatonville, WA 98328

Phone

(253) 693-0275

NPI assigned

Mar 12, 2024

Last updated

Mar 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexandra Senechal, LM, CPMNPI 1669254801

Title

Midwife/Owner

Phone

(253) 693-0275

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexandra Senechal, CPM, LM

  • Midwife
  • Roy, WA
  • NPI 1669254801
  NPD Authorized official

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1447018544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30902 12TH AVENUE CT E",
            "city": "ROY",
            "state": "WA",
            "postal_code": "985808806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 CENTER STREET E",
            "city": "EATONVILLE",
            "state": "WA",
            "postal_code": "98328",
            "telephone_number": "253-693-0275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MOUNTAIN MIDWIFERY, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-10",
        "status": "A",
        "authorized_official_last_name": "SENECHAL",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "MIDWIFE/OWNER",
        "authorized_official_telephone_number": "253-693-0275",
        "authorized_official_credential": "LM, CPM"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Midwife in Eatonville, WA
• Providers in Eatonville, WA by specialty
• Midwife in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.