Michelle L Klekota-Chisholm, MA, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH 60231172 Issued in WA

Practice address

9311 Bridgeport Way SW
Lakewood, WA 98499-1570

Phone

(253) 617-3559

Fax

(253) 486-1916

NPI assigned

Sep 3, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Lakewood Child and Family Counseling LLC

  • Mental Health Counselor
  • Lakewood, WA
  • NPI 1952635716
  NPD Authorized official
• Viridian Associates, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tacoma, WA
  • NPI 1093834350
  NPD (past)

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1740438779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9311 BRIDGEPORT WAY SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991570",
            "telephone_number": "253-985-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9311 BRIDGEPORT WAY SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991570",
            "telephone_number": "253-617-3559",
            "fax_number": "253-486-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEKOTA-CHISHOLM",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "MA, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "RC00057820",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH 60231172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Kiss, PT
• Brandi Nicole Kitchen-Loewen, CDPT
• Ashley Kiyohara
• Suzanne Klapiychuk, COTA
• Solongo Klawitter, SUDPT
• Shawna Michelle Klemann, HS
• Rachel Kletzker
• Jacqueline Kline
• Breanna R Klonitsko
• Chelsea Knapp

• Mental Health Counselor in Lakewood, WA
• Providers in Lakewood, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.