Active NPI
Alexandra Gloff Vannatta, LPC
- Mental Health Counselor
- Waco, TX
National Provider Identifier
1619497716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 84568
- Practice address
- 719 Jewell Dr
Waco, TX 76712-6624 - Phone
- (254) 870-1752
- NPI assigned
- Jun 21, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 37048 | TX | |
| Mental Health Counselor | 101YM0800X | 84568 | TX | Primary |
Addresses
Primary practice location
719 Jewell Dr
Waco, TX 76712-6624
Mailing address
575 W 4TH St
Crawford, TX 76638-3218
Other practice location 1
6701 Sanger Ave
Waco, TX 76710-7736
Phone (125) 439-9825
Other practice location 2
3500 Hillcrest Dr Ste 8
Waco, TX 76708-3144
Phone (254) 262-3506
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39048 | Other | TX | STATE BOARD OF EXAMINERS FOR SPEECH PATHOLOGY |
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 |
|---|---|---|---|
| 84568 | TX | MD | Mental Health Counselor |
| 37048 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653264000000",
"number": "1619497716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "575 W 4TH ST",
"city": "CRAWFORD",
"state": "TX",
"postal_code": "766383218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 JEWELL DR",
"city": "WACO",
"state": "TX",
"postal_code": "767126624",
"telephone_number": "254-870-1752"
}
],
"practiceLocations": [
{
"address_1": "6701 Sanger Ave",
"address_purpose": "LOCATION",
"city": "Waco",
"state": "TX",
"postal_code": "767107736",
"country_code": "US",
"telephone_number": "125-439-9825",
"fax_number": "254-399-8255",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3500 Hillcrest Dr Ste 8",
"address_purpose": "LOCATION",
"city": "Waco",
"state": "TX",
"postal_code": "767083144",
"country_code": "US",
"telephone_number": "254-262-3506",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VANNATTA",
"first_name": "ALEXANDRA",
"middle_name": "GLOFF",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-21",
"last_updated": "2022-05-23",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "37048",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "84568",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF EXAMINERS FOR SPEECH PATHOLOGY",
"identifier": "39048",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.