NPIMap

Organization Active NPI

Blue Water Behavioral Consulting LLC

  • Community/Behavioral Health Agency
  • Oak Harbor, WA
National Provider Identifier
1811311517
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BLUE WATER BEHAVIORAL CONSULTING LLC
Practice address
851 SE Pioneer Way
201
Oak Harbor, WA 98277
Phone
(360) 333-5684
Fax
(360) 230-3272
NPI assigned
Feb 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Authorized official

Name
Rachel Danielle Wagner, MS, LBA, BCBANPI 1669785028
Title
Ceo
Phone
(360) 333-5684

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X
Community/Behavioral Health Agency 251S00000X 1-10-7191
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

851 SE Pioneer Way
201
Oak Harbor, WA 98277

Mailing address

1777 S. Burlington Blvd
#465
Burlington, WA 98233
Phone (360) 333-5684

Other practice location 1

1777 S Burlington Blvd Ste 465
Burlington, WA 98233-3223
Phone (360) 333-5684

Other identifiers 1

IdentifierTypeStateIssuer
2041449MedicaidWA

National Provider Directory

National Provider Directory

Locations

1777 S Burlington Blvd
Burlington, WA 98233
Phone (360) 333-5684

851 SE Pioneer Way
Ste 201
Oak Harbor, WA 98277
Phone (360) 333-5684

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1392508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1811311517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 S. BURLINGTON BLVD",
            "address_2": "#465",
            "city": "BURLINGTON",
            "state": "WA",
            "postal_code": "98233",
            "telephone_number": "360-333-5684",
            "fax_number": "360-230-3272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 SE PIONEER WAY",
            "address_2": "201",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "98277",
            "telephone_number": "360-333-5684",
            "fax_number": "360-230-3272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1777 S Burlington Blvd Ste 465",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "WA",
            "postal_code": "982333223",
            "country_code": "US",
            "telephone_number": "360-333-5684",
            "fax_number": "360-230-3272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE WATER BEHAVIORAL CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-16",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-333-5684",
        "authorized_official_credential": "MS, LBA, BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": "1-10-7191",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2041449",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.