Gary Waters, LCSW, LMFT, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60737867 Issued in WA

Practice address

815 Eureka Dr
Friday Harbor, WA 98250-6910

Phone

(360) 317-4066

NPI assigned

Sep 7, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Juniper Consulting, LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1629327374
  NPD Authorized official
• Beacon Academy of Nevada

  • Local Education Agency (LEA)
  • Las Vegas, NV
  • NPI 1619229044
  NPD (past) Authorized official

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1548519291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 EUREKA DR",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982506910",
            "telephone_number": "360-317-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 EUREKA DR",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982506910",
            "telephone_number": "360-317-4066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1117 Spring St",
            "address_purpose": "LOCATION",
            "city": "Friday Harbor",
            "state": "WA",
            "postal_code": "982509782",
            "country_code": "US",
            "telephone_number": "360-378-2141",
            "fax_number": "360-378-1785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERS",
        "first_name": "GARY",
        "credential": "LCSW, LMFT, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-07",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NV",
            "license": "22343",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "000357-C",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NV",
            "license": "22343",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NV",
            "license": "0127",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "426-LC",
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "NV",
            "license": "22343",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "13653",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60737867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Village at Home
• Village at the Harbor
• John Stanford Wakeman, D.D.S.
• Lauren Wall, RN, IBCLC
• Washington Institute of Natural Sciences (W.I.N.S. Integrated Medical Clinic)
• Bonita Wegenast, LMP
• Inge M. Wendelberger, M.A., CDPT
• Sarah Elizabeth Werling, MSW, LICSW
• Melissa Marie Wickey, LMT, EAMP
• Jerry Wickman, D.C.

• Clinical Social Worker in Friday Harbor, WA
• Providers in Friday Harbor, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.