Kellie K Peyton

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CG61213922 Issued in WA

Practice address

165 E Hawthorne Ave
Colville, WA 99114-2629

Phone

(509) 684-4597

NPI assigned

Aug 24, 2021

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 names 1

• Kellie K Walker Former name

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.

• Stevens County

  • Mental Illness Community Based Residential Treatment Facility
  • Colville, WA
  • NPI 1922517192
  NPD (past)

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1326715723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 E HAWTHORNE AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142629",
            "telephone_number": "509-684-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 E HAWTHORNE AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142629",
            "telephone_number": "509-684-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEYTON",
        "first_name": "KELLIE",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG61213922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "WALKER",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Linda M Pazereckas, LMHC, MS, DMHP
• Matthew Pecquex, PT
• Siarah Keola Perreira
• Lawrence Dean Perryman
• Caitlin Marie Peterson
• Logan S Phelps
• Claudia Phillips, OT
• Jennifer M Phillips
• Sarah J Pinkham
• Jacqueline Poff

• Counselor in Colville, WA
• Providers in Colville, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.