Active NPI
Boss White
- Professional Counselor
- Lakewood, WA
National Provider Identifier
1780384602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- MC61427113
- Practice address
- 9125 Bridgeport Way SW Ste 102
Lakewood, WA 98499-2448 - Phone
- (253) 215-2836
- Fax
- (253) 366-7422
- NPI assigned
- Mar 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | MC61427113 | WA | Primary |
Addresses
Primary practice location
9125 Bridgeport Way SW Ste 102
Lakewood, WA 98499-2448
Mailing address
9125 Bridgeport Way SW Ste 102
Lakewood, WA 98499-2448
Phone (253) 215-2836
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 |
|---|---|---|---|
| MC61427113 | WA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anchor Christian Counseling, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729468800000",
"number": "1780384602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9125 BRIDGEPORT WAY SW STE 102",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984992448",
"telephone_number": "253-215-2836",
"fax_number": "253-366-7422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9125 BRIDGEPORT WAY SW STE 102",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984992448",
"telephone_number": "253-215-2836",
"fax_number": "253-366-7422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "BOSS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-08",
"last_updated": "2024-10-21",
"certification_date": "2024-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WA",
"license": "MC61427113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.