Michael Joseph Vodusek, LPC, CADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC013673 Issued in PA

Practice address

110 E Main St Ste 1
North East, PA 16428-1333

Phone

(814) 347-5018

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Watershed Counseling Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • North East, PA
  • NPI 1548778202
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1700997178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 WEST MAIN STREET",
            "address_2": "SUITE 110",
            "city": "NORTH EAST",
            "state": "PA",
            "postal_code": "164281333",
            "telephone_number": "814-347-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E MAIN ST STE 1",
            "city": "NORTH EAST",
            "state": "PA",
            "postal_code": "164281333",
            "telephone_number": "814-347-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VODUSEK",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "LPC, CADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "16438",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC013673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "PC013678",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA CERTIFICATION BOARD- CADC",
            "identifier": "16438",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Lee Triana
• Michael F Turner, DMD
• Sheryl Diane Urban
• Nina Vance
• Vineyard Home Care, LLC
• Julia Sue Wagner
• Thomas Allan Walters, D.M.D.
• Watershed Counseling Services, LLC
• Julianne L Watts, PT
• Kristine Marie Weigle, LPC

• Professional Counselor in North East, PA
• Providers in North East, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.