Mark Carl Sivesind, SUDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

61083927 Issued in WA

Practice address

806 S Vine St
Port Angeles, WA 98362-7982

Phone

(360) 452-2443

Fax

(360) 452-2738

NPI assigned

Sep 15, 2020

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

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1457966418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 S VINE ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983627982",
            "telephone_number": "360-452-2443",
            "fax_number": "360-452-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 S VINE ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983627982",
            "telephone_number": "360-452-2443",
            "fax_number": "360-452-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVESIND",
        "first_name": "MARK",
        "middle_name": "CARL",
        "credential": "SUDPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "61083927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Renee Silvas, CDP
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• Wendy Ann Sisk, LMCH
• John Whiting Sisson, MD
• Christine Rose Size
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• Samuel Roth Skovgaard, M.D.
• Daniel Forrest Slack, CRNA

• Addiction (Substance Use Disorder) Counselor in Port Angeles, WA
• Providers in Port Angeles, 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 Sep 15, 2020; 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.