Active NPI
Phyllis Ann Dickenson
- Mental Health Counselor
- Bellevue, WA
National Provider Identifier
1811524382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC61033567
- Practice address
- 2105 112TH Ave NE Ste 200
Bellevue, WA 98004-2945 - Phone
- (408) 761-3766
- NPI assigned
- Mar 25, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC61033567 | WA | Primary |
Addresses
Primary practice location
2105 112TH Ave NE Ste 200
Bellevue, WA 98004-2945
Mailing address
2105 112TH Ave NE Ste 200
Bellevue, WA 98004-2945
Phone (408) 761-3766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC61033567 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1811524382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2105 112TH AVE NE STE 200",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980042945",
"telephone_number": "408-761-3766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 112TH AVE NE STE 200",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980042945",
"telephone_number": "408-761-3766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKENSON",
"first_name": "PHYLLIS",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-25",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC61033567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.