Active NPI
Jdrew McKibben, MA, MHP
- Mental Health Counselor
- Monroe, WA
National Provider Identifier
1215047048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MCKIBJD415M3
- Practice address
- 1022 W Main St
Monroe, WA 98272-2018 - Phone
- (425) 349-8826
- Fax
- (425) 349-8815
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MCKIBJD415M3 | WA | Primary |
Addresses
Primary practice location
1022 W Main St
Monroe, WA 98272-2018
Mailing address
1411 228TH CT NE
Sammamish, WA 98074-6557
Phone (425) 868-2891
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MCKIBJD415M3 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215047048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 228TH CT NE",
"city": "SAMMAMISH",
"state": "WA",
"postal_code": "980746557",
"telephone_number": "425-868-2891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1022 W MAIN ST",
"city": "MONROE",
"state": "WA",
"postal_code": "982722018",
"telephone_number": "425-349-8826",
"fax_number": "425-349-8815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKIBBEN",
"first_name": "JDREW",
"name_prefix": "Mrs.",
"credential": "MA, MHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MCKIBJD415M3",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.