Matthew E. Wadzita

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH61160894 Issued in WA

Practice address

12503 SE Mill Plain Blvd Ste 119a
Vancouver, WA 98684-4007

Phone

(360) 314-6507

Fax

(360) 852-8041

NPI assigned

Jan 8, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Affinity Counseling and Treatment

  • Community/Behavioral Health Agency
  • Vancouver, WA
  • NPI 1922332188
  NPD (past)

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1467925875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12503 SE MILL PLAIN BLVD STE 119A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844007",
            "telephone_number": "360-314-6507",
            "fax_number": "360-852-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12503 SE MILL PLAIN BLVD STE 119A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844007",
            "telephone_number": "360-314-6507",
            "fax_number": "360-852-8041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADZITA",
        "first_name": "MATTHEW",
        "middle_name": "E.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-08",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61160894",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C6973",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Daniel Waddington
• Sally Marie Waddle, PA-C
• Andrew Wade, DC
• Nicole Kathleen Wade, RN
• Jeanie Nicole Wadiak, CDPT, MHCA
• Pamela Wadzita, M. ED. LMHC
• Jeanie Wagener, MS, CCC
• Andromyda Wagenman
• Shawn Michelle Wager, L.P.N.
• Ami M Waggoner

• Mental Health Counselor in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; 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.