Wild Goose Counseling LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WILD GOOSE COUNSELING LLC

Practice address

198 W Marydale Ave
Soldotna, AK 99669-7501

Phone

(907) 953-9614

NPI assigned

Jun 5, 2017

Last updated

Jun 5, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lydia Anna Davis, LPC. MAC

Title

Co-Owner

Phone

(907) 953-9614

Specialties & licenses 3

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lydia Anna Bird, LPC, MAC

  • Professional Counselor
  • Soldotna, AK
  • NPI 1477082410
  NPD (past)

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496620800000",
    "number": "1891224879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 W KATMAI AVE",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697315",
            "telephone_number": "907-953-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 W MARYDALE AVE",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697501",
            "telephone_number": "907-953-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD GOOSE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-05",
        "last_updated": "2017-06-05",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "ANNA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "907-953-9614",
        "authorized_official_credential": "LPC. MAC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AK",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "AK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR LYDIA DAVIS",
            "identifier": "109622",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR MOLLY DAVIS",
            "identifier": "109623",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Norma Josefink Whitmore
• Widening Circles LLC
• Ashley Christine Wiedermann, PLPC
• Peggy Wilburn
• Amanda Starr-Marrie Wilcox
• Cheyanne Michelle Willard, RBT
• Allen N Williams, DC
• Krystin Williams, LPC
• Laura Williams, IBCLC
• Avea Nicole Williamson

• Mental Health Clinic/Center (Including Community Mental Health Center) in Soldotna, AK
• Providers in Soldotna, AK by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2017; 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.