Active NPI
Mark Edward Wakefield, MA, MBA
- Mental Health Counselor
- Madison, WI
National Provider Identifier
1568617702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 479226
- Practice address
- 1709 S Park St
Madison, WI 53713-1200 - Phone
- (608) 223-0017
- Fax
- (608) 223-0019
- NPI assigned
- Dec 1, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 13764132 | WI | |
| Mental Health Counselor | 101YM0800X | 479226 | WI | Primary |
Addresses
Primary practice location
1709 S Park St
Madison, WI 53713-1200
Mailing address
PO Box 7370
Madison, WI 53707-7370
Phone (608) 223-0017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts, Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13764132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 479226 | WI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1568617702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7370",
"city": "MADISON",
"state": "WI",
"postal_code": "537077370",
"telephone_number": "608-223-0017",
"fax_number": "608-223-0019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1709 S PARK ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537131200",
"telephone_number": "608-223-0017",
"fax_number": "608-223-0019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKEFIELD",
"first_name": "MARK",
"middle_name": "EDWARD",
"credential": "MA, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-01",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "13764132",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "479226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.