Jake Alex Mehl, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

261QR0405X

Practice address

2732 Grand Ave
Everett, WA 98201-3416

Phone

(425) 258-2407

NPI assigned

Dec 26, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mrs. Kathleen Ann Mehl Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Evergreen Recovery Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Everett, WA
  • NPI 1124159157
  NPD

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

{
    "created_epoch": "1545782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1750853057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 GRAND AVENUE",
            "address_2": "SUITE 101",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013416",
            "telephone_number": "206-940-0867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2732 GRAND AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013416",
            "telephone_number": "425-258-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHL",
        "first_name": "JAKE",
        "middle_name": "ALEX",
        "name_prefix": "Mr.",
        "credential": "SUDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-26",
        "last_updated": "2023-08-30",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": "261QR0405X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERGREEN RECOVERY CENTER",
            "identifier": "1124159157",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "MEHL",
            "middle_name": "ANN",
            "prefix": "MRS.",
            "credential": "SUDP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Patricia Meier-Countryman
• Cynthia Andrea Meier, MD
• Elizabeth Meier
• Michael Louis Meier, DC

• Addiction (Substance Use Disorder) Counselor in Everett, WA
• Providers in Everett, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.