Phillip Krulisky, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1500000323 Issued in CA

Practice address

159 Brentwood Dr
Grass Valley, CA 95945-5703

Phone

(530) 878-5166

NPI assigned

Mar 13, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Granite Wellness Centers

  • Substance Abuse Rehabilitation Facility
  • Grass Valley, CA
  • NPI 1285860403
  NPD (past)

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1073214532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6021",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956046021",
            "telephone_number": "530-878-5166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 BRENTWOOD DR",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455703",
            "telephone_number": "530-878-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRULISKY",
        "first_name": "PHILLIP",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1500000323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zoe Jade Livingston Krause
• Mervin Peter Kril, MD
• Jessa Marie Krissovich, CMT
• Rene Cathleen Kronland, MD
• Robert Francis Krueger, LCSW
• Presley Angelica Kennedy Lee Krutiak
• Sharal Marlena Krzyzopolski, SUDCC
• Michelle Kucera, DDS
• Kuldip Gill M D P C
• Ganesh Arun Kulkarni, M.D;

• Addiction (Substance Use Disorder) Counselor in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.