Jennifer Marcella Wirt, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH61306829 Issued in WA

Practice address

300 Ocean Ave
Raymond, WA 98577-3016

Phone

(360) 942-3040

Fax

(360) 942-3955

NPI assigned

Nov 16, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Chehalis, WA
  • NPI 1134164692
  Medicare reassignment NPD
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Centralia, WA
  • NPI 1811669658
  NPD
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Toledo, WA
  • NPI 1942569637
  NPD

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1902409709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985773016",
            "telephone_number": "360-942-3040",
            "fax_number": "360-942-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRT",
        "first_name": "JENNIFER",
        "middle_name": "MARCELLA",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-16",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61306829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2212708",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Willapa Harbor Care LLC
• Willapa Nursing & Rehab LLC
• Willapa Valley School District
• Alysha Renee Williams, MA 60632924
• Sheila Marie Williams, L.M.P.
• Perry Joe Wise, N.D.
• Crystal Wolfe
• Matthew J Woodard, M.ED., BCBA
• Lauren Alyse Woodbeck
• Dawn Wright

• Mental Health Counselor in Raymond, WA
• Providers in Raymond, 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 Sep 18, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.