Mitchel James Mortenson, AAC

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

2204 Pacific Ave N
Long Beach, WA 98631-3300

Phone

(360) 642-3787

NPI assigned

Sep 3, 2021

Last updated

Nov 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1962170910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 PACIFIC AVE N",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "986313300",
            "telephone_number": "360-642-3787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 PACIFIC AVE N",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "986313300",
            "telephone_number": "360-642-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSON",
        "first_name": "MITCHEL",
        "middle_name": "JAMES",
        "credential": "AAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-03",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760008783",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.willapabh.org/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2204 Pacific Ave N",
            "city": "Long Beach",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986313300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James Robert Miller, C.N.A
• Shane Todd Milward
• Annita F Monteith
• Arwen Moody
• Jared Mortenson
• Amy Murray
• Maddilyn Murray
• Mary Anne Christine Murray, ARNP
• David Leroy Nicholson-Klingerman Sr., MA LPC, LMHC, CMHS
• Michael Nolan

• Peer Specialist in Long Beach, WA
• Providers in Long Beach, WA by specialty
• Peer Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.