Individual provider Active NPI

Kevin Xiong, MA, LMHC, MHP

  • Counselor
  • Vancouver, WA
National Provider Identifier
1336747104
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
LH61420359 Issued in WA
Practice address
1498 SE Tech Center PL Ste 300
Vancouver, WA 98683-5509
Phone
(360) 619-2226
Fax
(360) 326-9691
NPI assigned
Oct 14, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LH61420359 WA
Professional Counselor 101YP2500X LH61420359 WA
Counselor 101Y00000X LH61420359 WA Primary

Addresses

Primary practice location

1498 SE Tech Center PL Ste 300
Vancouver, WA 98683-5509

Mailing address

1498 SE Tech Center PL Ste 300
Vancouver, WA 98683-5509
Phone (360) 619-2226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240802003494 WA Practitioner - Mental Health Counselor 5496292823 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LH61420359WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Real Life Community Behavioral Health PLLC Mental Health CurrentSince Dec 8, 2024 Accepting new patients

Locations

1498 SE Tech Center Pl
Ste 180
Vancouver, WA 98683
Phone (360) 200-8670

3606 Main St
Ste 205
Vancouver, WA 98663
Phone (360) 200-8670

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1336747104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1498 SE TECH CENTER PL STE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986835509",
            "telephone_number": "360-619-2226",
            "fax_number": "360-326-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1498 SE TECH CENTER PL STE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986835509",
            "telephone_number": "360-619-2226",
            "fax_number": "360-326-9691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XIONG",
        "first_name": "KEVIN",
        "credential": "MA, LMHC, MHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-14",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61420359",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "LH61420359",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "LH61420359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.