Mark Weatherwax, MS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

6301015902 Issued in MI

Practice address

519 S Park St
Kalamazoo, MI 49007-5117

Phone

(269) 903-0551

NPI assigned

Nov 13, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Kalamazoo Probation Enhancement Program

  dba Kpep

  • Addiction (Substance Use Disorder) Counselor
  • Kalamazoo, MI
  • NPI 1922498393
  NPD (past)

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542067200000",
    "number": "1841768421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 S PARK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075117",
            "telephone_number": "269-903-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 S PARK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075117",
            "telephone_number": "269-903-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERWAX",
        "first_name": "MARK",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-13",
        "last_updated": "2018-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6301015902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wayne Counseling & Consultation, LLC
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• Ryann Weatherly
• Stephanie Inez Weatherspoon, BD,PD, LCCE
• Addie Frances Weaver
• Kibwe Akin Weaver, M.D.
• Stephen Francis Weaver, LLMSW
• Susan Lyn Weaver, LCSW, ACSW
• Alayna Webb, OTR/L

• Addiction (Substance Use Disorder) Counselor in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; 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.