Active NPI
Kendall K Wadsworth, M.S., LPC
- Professional Counselor
- San Angelo, TX
National Provider Identifier
1609172873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 84491
- Practice address
- 11569 Northcross LN
San Angelo, TX 76904-3617 - Phone
- (325) 650-2102
- NPI assigned
- Feb 4, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 84491 | TX | Primary |
Addresses
Primary practice location
11569 Northcross LN
San Angelo, TX 76904-3617
Mailing address
11569 Northcross LN
San Angelo, TX 76904-3617
Phone (325) 650-2102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396867966 | Medicaid | TX |
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 84491 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655942400000",
"number": "1609172873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11569 NORTHCROSS LN",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769043617",
"telephone_number": "325-650-2102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11569 NORTHCROSS LN",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769043617",
"telephone_number": "325-650-2102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADSWORTH",
"first_name": "KENDALL",
"middle_name": "K",
"name_prefix": "Mrs.",
"credential": "M.S., LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-04",
"last_updated": "2022-06-23",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "84491",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1396867966",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
- Giang Vu
- Krishna Vukoti, BS(PHARM), MTECH PHD
- Marius Vulcan, M.D.
- W.Gordy Day,M.D.LLC
- George Kevin Wade, LCSW
- Michael A Wagnon, DO
- Morgan Blake Wake, PA-C
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-7311)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-7281)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-1249)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.