Active NPI
Eric Kammersgard, LMFT
- Mental Health Counselor
- Colville, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LH60977038
- Practice address
- 165 E Hawthorne Ave
Colville, WA 99114-2629 - Phone
- (509) 684-4597
- Fax
- (509) 684-5286
- NPI assigned
- Feb 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC 30864 | CA | |
| Case Manager/Care Coordinator | 171M00000X | |||
| Mental Health Counselor | 101YM0800X | LH60977038 | WA | Primary |
Addresses
Primary practice location
165 E Hawthorne Ave
Colville, WA 99114-2629
Mailing address
165 E Hawthorne Ave
Colville, WA 99114-2629
Phone (509) 684-4597
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41688 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
6505 216TH St SW
Suite 100
Mountlake Terrace, WA 98043-2089
Phone (425) 640-7009
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH60977038 | WA | MD | Mental Health Counselor |
| MFC 30864 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Therapy Group PC | Mental Health | Current | Accepting new patients |
Locations
6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463
21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698
320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113
Organizations & group practices 1
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.
-
dba Mindful Therapy Group
- Clinical Social Worker
- Mountlake Terrace, WA
- NPI 1316238678
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580860800000",
"number": "1568505345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 E HAWTHORNE AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142629",
"telephone_number": "509-684-4597",
"fax_number": "509-684-5286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 E HAWTHORNE AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142629",
"telephone_number": "509-684-4597",
"fax_number": "509-684-5286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAMMERSGARD",
"first_name": "ERIC",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-14",
"last_updated": "2020-02-05",
"certification_date": "2020-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC 30864",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH60977038",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41688",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Colville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.