Active NPI
Kylie Casebolt
- Addiction (Substance Use Disorder) Psychologist
- Chehalis, WA
National Provider Identifier
1346967445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Psychologist
- License
- CO61277888
- Practice address
- 505 SE Adams Ave
Chehalis, WA 98532-3031 - Phone
- (360) 280-8116
- NPI assigned
- Oct 20, 2022
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | CO61277888 | WA | Primary |
Addresses
Primary practice location
505 SE Adams Ave
Chehalis, WA 98532-3031
Mailing address
505 SE Adams Ave
Chehalis, WA 98532-3031
Phone (360) 280-8116
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000000 | Other | WA | ABHS |
| CO61277888 | Other | WA | NA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kcaseblt@abhsinc.net | Other |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO61277888 | WA | MD | Addiction (Substance Use Disorder) Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666224000000",
"number": "1346967445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 SE ADAMS AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985323031",
"telephone_number": "360-280-8116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 SE ADAMS AVE",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985323031",
"telephone_number": "360-280-8116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASEBOLT",
"first_name": "KYLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-20",
"last_updated": "2022-10-20",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CO61277888",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ABHS",
"identifier": "000000000",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "CO61277888",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kcaseblt@abhsinc.net",
"affiliation": "N",
"endpointDescription": "kcasebolt",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "123456",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "505 SE Adams Ave",
"city": "Chehalis",
"state": "WA",
"country_code": "US",
"postal_code": "985323031",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chehalis, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.