Michelle Buckholz, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60551022 Issued in WA

Practice address

621 Grade St
Kelso, WA 98626-2606

Phone

(360) 425-9210

NPI assigned

Apr 9, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Cowlitz Family Health Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Kelso, WA
  • NPI 1104243534
  NPD (past)

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

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1215323977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-425-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 GRADE ST",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986262606",
            "telephone_number": "360-425-9210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2232 S Silver Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Castle Rock",
            "state": "WA",
            "postal_code": "986118021",
            "country_code": "US",
            "telephone_number": "360-274-3262",
            "fax_number": "360-274-3345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKHOLZ",
        "first_name": "MICHELLE",
        "credential": "SUDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-09",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60551022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2088085",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Brewer, LPN
• Melissa Brinkerhoff, NP
• Jordan Lee Brooks, MS MHCA SUDP CPC
• Kesiah Anne Brown
• Teresa Lee Brunelle, CDPT
• Rachelle Ann Burgener
• C & R Executives, LLC
• Heather Caesar, M.S., CCC-SLP
• Richelle Cain
• Teresea Joann Carson, LMP

• All providers in Kelso, WA
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.