Michael Graham Waxlax, LADC, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4158 Issued in MN

Practice address

230 1St St
Mora, MN 55051-1330

Phone

(218) 969-1943

NPI assigned

Dec 1, 2022

Last updated

Mar 6, 2024By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1801506704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 ROWLAND RD",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550517119",
            "telephone_number": "320-364-1300",
            "fax_number": "651-323-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 1ST ST",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511330",
            "telephone_number": "218-969-1943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAXLAX",
        "first_name": "MICHAEL",
        "middle_name": "GRAHAM",
        "credential": "LADC, LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-01",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303086",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Louise Vlieger, PHARMD
• Dustin Peter Voss, PA-C
• Katie Lorraine Voss, MA, LPCC
• Lori K Voss, MS LMFT
• Linda Marie Walinski, LP LICENSED PSYCHOLO
• Robert M. Weeks, MD
• Welia Health
• Welia Health
• Welia Health
• Welia Health

• Professional Counselor in Mora, MN
• Providers in Mora, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.