NPIMap

Organization Active NPI

Nooksack Central Management System

  • Mental Health Counselor
  • Everson, WA
National Provider Identifier
1487869095
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Practice address
6750 Mission Rd
Everson, WA 98247-9749
Phone
(360) 966-7704
Fax
(360) 966-4225
NPI assigned
May 14, 2007
Last updated
Sep 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Authorized official

Name
Eric R Davenport
Title
Government Service Exec
Phone
(360) 952-5176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X WA Primary

Addresses

Primary practice location

6750 Mission Rd
Everson, WA 98247-9749

Mailing address

PO Box 157
Deming, WA 98244-0157
Phone (360) 966-7704

Other identifiers 1

IdentifierTypeStateIssuer
1980911MedicaidWA

Other names 1

  • The Nooksack Hope Behavorial Health Program Other name

National Provider Directory

National Provider Directory
Tax ID family
Nooksack Central Management System8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1487869095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "city": "DEMING",
            "state": "WA",
            "postal_code": "982440157",
            "telephone_number": "360-966-7704",
            "fax_number": "360-966-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 MISSION RD",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982479749",
            "telephone_number": "360-966-7704",
            "fax_number": "360-966-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOOKSACK CENTRAL MANAGEMENT SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "GOVERNMENT SERVICE EXEC",
        "authorized_official_telephone_number": "360-952-5176"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1980911",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Nooksack Hope Behavorial Health Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Everson, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; 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.