Kimberly Joy Wilson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

R7572 Issued in OR

Practice address

11105 NE 14TH St Ste 103
Vancouver, WA 98684-4309

Phone

(503) 850-8088

NPI assigned

Apr 29, 2020

Sex

Female

Sole proprietor

Yes

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Ashes and Joy Counseling, LLC

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1659132298
  NPD Authorized official

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1760003958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11192 SE 52ND CT",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972223500",
            "telephone_number": "503-850-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11105 NE 14TH ST STE 103",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844309",
            "telephone_number": "503-850-8088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11192 SE 52nd Ct",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972223500",
            "country_code": "US",
            "telephone_number": "503-850-8088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "JOY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-29",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R7572",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61308406",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kady Wilson
• Karen M Wilson, LMP
• Karrie Larae Wilson, LMP
• Katelyn Wilson, LMSW
• Kiera Ileen Ettie Wilson
• Kip L Wilson, LMP LMT
• Kyle Richard Ikaika Wilson, DC
• Lizamarie Ann Wilson, CPC
• Marguerite Claire Wilson, PHD
• Martha E Wilson, MA

• Mental Health Counselor in Vancouver, WA
• Providers in Vancouver, 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 Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.