Active NPI
Kathleen A Waggoner, LPC
- Professional Counselor
- Farmington, MO
National Provider Identifier
1609971886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2004014231
- Practice address
- 400 N Washington St Ste 111
Farmington, MO 63640-1731 - Phone
- (573) 664-1117
- Fax
- (573) 664-1117
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 2004014231 | MO | Primary |
Addresses
Primary practice location
400 N Washington St Ste 111
Farmington, MO 63640-1731
Mailing address
RR 2 Box 2335
Sedgewickville, MO 63781-9706
Phone (573) 576-1936
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202194 | Other | MO | BLUE CROSS BLUE SHIELD |
| 738553 | Other | MO | HEALTHLINK |
| 499297703 | Medicaid | MO | |
| 431344414WAG | Other | MO | UNITY MANAGED MENTAL HEAL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004014231 | MO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Natural Solutions Counseling | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Park Hills, MO
- NPI 1104102557
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569369600000",
"number": "1609971886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 2 BOX 2335",
"city": "SEDGEWICKVILLE",
"state": "MO",
"postal_code": "637819706",
"telephone_number": "573-576-1936",
"fax_number": "573-664-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N WASHINGTON ST STE 111",
"city": "FARMINGTON",
"state": "MO",
"postal_code": "636401731",
"telephone_number": "573-664-1117",
"fax_number": "573-664-1117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "KATHLEEN",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2019-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2004014231",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "202194",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "738553",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "499297703",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITY MANAGED MENTAL HEAL",
"identifier": "431344414WAG",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.