Misty Rae Southall, LICSW, MHP, CPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

31849 Issued in CA

Practice address

312 W 8TH Ave
Spokane, WA 99204-2506

Phone

(714) 336-6596

NPI assigned

Oct 28, 2010

Sex

Female

Sole proprietor

Yes

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)

Enrolled

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.

• Spokane County

  • Community/Behavioral Health Agency
  • Spokane, WA
  • NPI 1932302411
  NPD (past)

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1487954145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042506",
            "telephone_number": "509-477-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042506",
            "telephone_number": "714-336-6596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHALL",
        "first_name": "MISTY",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "LICSW, MHP, CPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-28",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "31849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Hill Spinal Care
• South Hill Spinal Care,LLC
• South Perry Endoscopy PLLC
• South Perry Endoscopy PLLC
• South Sound Inpatient Physicians PLLC
• Justin Southward, DMD
• Cory R Southwick, RN
• Hannah Nicole Southwick, RN
• Johnathon Souza
• Alex L Sov, OD

• Mental Health Counselor in Spokane, WA
• Providers in Spokane, 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 Sep 11, 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.