Mario Gaspar de Alba

Primary specialty

Family PsychologistTaxonomy code 103TF0000X

License

MG60848499 Issued in WA

Practice address

301 W North Bend Way
North Bend, WA 98045-8163

Phone

(425) 200-0130

Fax

(425) 209-0766

NPI assigned

Jun 20, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 14, 2025 through Jan 14, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1841921046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W NORTH BEND WAY",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980458163",
            "telephone_number": "425-200-0130",
            "fax_number": "425-209-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W NORTH BEND WAY",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980458163",
            "telephone_number": "425-200-0130",
            "fax_number": "425-209-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GASPAR DE ALBA",
        "first_name": "MARIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "WA",
            "license": "MG60848499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mario@larchcounseling.com",
            "affiliation": "N",
            "endpointDescription": "Internship Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "301 W North Bend Way",
            "city": "North Bend",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980458163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Caroline Fletcher, RN
• Amber Follini, LPN
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• Rodger A. Galloway, D.D.S.
• Kelly Rae Garwood, DDS
• Erica Gonzalez
• Grace Gonzalez
• Krista Gordon, SLP
• Dina K Gosse, L.AC., LMP
• Emma Gould, ND

• Family Psychologist in North Bend, WA
• Providers in North Bend, WA by specialty
• Family Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.