Active NPI
Michael Connolly
- Behavior Analyst
- Tacoma, WA
National Provider Identifier
1003240177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- CG60396523
- Practice address
- 1826 Markham Ave NE # B
Tacoma, WA 98422-1015 - Phone
- (541) 637-6855
- NPI assigned
- Aug 26, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | CG60396523 | WA | Primary |
Addresses
Primary practice location
1826 Markham Ave NE # B
Tacoma, WA 98422-1015
Mailing address
PO Box 3841
Federal Way, WA 98063-3841
Phone (541) 637-6855
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60396523 | WA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1003240177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3841",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980633841",
"telephone_number": "541-637-6855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1826 MARKHAM AVE NE # B",
"city": "TACOMA",
"state": "WA",
"postal_code": "984221015",
"telephone_number": "541-637-6855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-26",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WA",
"license": "CG60396523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.