Jalon Alexander McCullough

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

542 4TH Ave Ste B-101
Fairbanks, AK 99701-4707

Phone

(907) 374-1097

Fax

(907) 374-1062

NPI assigned

Aug 19, 2020

Last updated

Aug 19, 2020By 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 1

Addresses

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": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1104438365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73004",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997073004",
            "telephone_number": "907-374-1097",
            "fax_number": "907-374-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 4TH AVE STE B-101",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014707",
            "telephone_number": "907-374-1097",
            "fax_number": "907-374-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JALON",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Devon McCormick, LCSW
• Geoffry McCormick
• Sylvia Ann McCormick, P.A.
• Jensyn McCray
• Cameron Ray McCullough
• Laura McDaniels
• Brier McDermott
• Janet Elaine McDermott, LCSW
• Brittney Danielle McDevitt
• Marion Constance McDevitt, DO

• Addiction (Substance Use Disorder) Counselor in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Addiction (Substance Use Disorder) Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.