Krista M McCulloch, LSW
Individual provider Active NPI Clinical Social Worker · Maumee, OH
NPI 1124453907 · NPPES record last updated Mar 13, 2020
Key facts
- NPI
- 1124453907
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- S.0800738 (OH)
- Practice address
- 1627 Henthorne Dr Ste C
Maumee, OH 43537-1370 - Phone
- (419) 491-0420
- NPI assigned
- Sep 11, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Anchored in Hope Counseling, LLC
Practice addresses (Care Compare)
1690 Woodlands Dr
Suite 200
Maumee, OH 43537-4045
Phone (419) 491-0420
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200512001471 | OH | Practitioner - Clinical Social Worker | 0749611564 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.0800738 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anchored in Hope Counseling, LLC | Clinical | Current |
Accepting new patients |
| Anchored in Hope Counseling, LLC | Current |
Accepting new patients | |
| Beech Brook | Past | Accepting new patients |
Locations
1627 Henthorne Dr
Ste C
Maumee, OH 43537
Phone (419) 491-0420
1690 Woodlands Dr
Ste 200
Maumee, OH 43537
Phone (419) 491-0420
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | S.0800738 | OH | Yes |
Addresses
Primary practice location
1627 Henthorne Dr Ste C
Maumee, OH 43537-1370
Mailing address
PO Box 823
Perrysburg, OH 43552-0823
Phone (419) 491-0420
Other practice location 1
11801 Buckeye Rd
Cleveland, OH 44120-2620
Phone (216) 831-2255
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2871101 | Medicaid | OH |
Other providers in Maumee, OH
- Ashley McClain
- Angela McClellan
- Kurt David McClurg
- Ashlee McCoy
- Michael Andrew McCray
- Mila Shavel McFall
- Ryan McFann
- Nyia McFarland-Clemons
- Mary McGill
- Stephanie Lee McGill
All providers in Maumee, OH · Clinical Social Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.