Active NPI
Julian Rafferty McCullough, PHD, LPC, LMHC
- Mental Health Counselor
- Vancouver, WA
National Provider Identifier
1265165153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MX61291003
- Practice address
- 1307 NE 43Rd St
Vancouver, WA 98663-3619 - Phone
- (206) 898-9421
- NPI assigned
- Jul 7, 2022
- Last updated
- Jul 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C5864 | OR | |
| Mental Health Counselor | 101YM0800X | LPC009458 | GA | |
| Mental Health Counselor | 101YM0800X | MX61291003 | WA | Primary |
Addresses
Primary practice location
1307 NE 43Rd St
Vancouver, WA 98663-3619
Mailing address
1307 NE 43Rd St
Vancouver, WA 98663-3619
Phone (206) 898-9421
Other names 1
- Dr. Rafe McCullough
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC009458 | GA | MD | Mental Health Counselor |
| C5864 | OR | MD | Mental Health Counselor |
| MX61291003 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piiq Space PC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657152000000",
"number": "1265165153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1307 NE 43RD ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986633619",
"telephone_number": "206-898-9421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1307 NE 43RD ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986633619",
"telephone_number": "206-898-9421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "JULIAN",
"middle_name": "RAFFERTY",
"name_prefix": "Dr.",
"credential": "PHD, LPC, LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-07",
"last_updated": "2022-07-07",
"certification_date": "2022-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "C5864",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC009458",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MX61291003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RAFE",
"last_name": "MCCULLOUGH",
"prefix": "DR.",
"credential": "PHD, LPC, LMHC",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.