Marisa Kelly Rose Fernandez

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC61588298 Issued in WA

Practice address

1616 Cornwall Ave Ste 205
Bellingham, WA 98225-4642

Phone

(360) 676-6177

Fax

(360) 671-3574

NPI assigned

Mar 7, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Unity Care NorthwestGroup PAC ID 7911897699, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Unity Care Northwest

  • Federally Qualified Health Center (FQHC)
  • Bellingham, WA
  • NPI 1760430532
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1871293944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 WILDFLOWER WAY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982295364",
            "telephone_number": "831-241-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 CORNWALL AVE STE 205",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982254642",
            "telephone_number": "360-676-6177",
            "fax_number": "360-671-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "MARISA",
        "middle_name": "KELLY ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-07",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61588298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn J Fentress, PHD
• Jayme Dee Fergoda, PH.D., LICSW
• Emily Anne Ferguson, SWAIC
• Jeri Ferguson
• Kylie Ann Ferguson, MS RDN
• Dardo Enrique Ferrara, MD
• Jason Kent Ferrari, MD
• Abigail Ferreira, PHARMD RPH
• Jacob Smith Ferris
• Patrick William Ferry, D.C.

• Mental Health Counselor in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.