NPIMap

Organization Active NPI

Kllallam Couseling Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Port Angeles, WA
National Provider Identifier
1396012530
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
CP00004528 Issued in WA
Legal business name
KLLALLAM COUSELING SERVICES
Practice address
1026 East Front St.
#2
Port Angeles, WA 98362
Phone
(360) 452-4432
Fax
(360) 452-4599
NPI assigned
Nov 16, 2011
Last updated
Nov 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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

Authorized official

Name
Mr. Kevin D Collins, CB00017145NPI 1013098219
Title
Administrator
Phone
(360) 452-4432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X CP00004528 WA Primary

Addresses

Primary practice location

1026 East Front St.
#2
Port Angeles, WA 98362

Mailing address

73 Nisbet Rd
Sequ
Sequim, WA 98382-7314
Phone (360) 681-8092

Other identifiers 1

IdentifierTypeStateIssuer
CP00004528MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Lower Elwah Band of Klallam8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1026 E FRNT St
2
Port Angeles, WA 98362
Phone (360) 452-4432

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321401600000",
    "number": "1396012530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 NISBET RD",
            "address_2": "SEQU",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983827314",
            "telephone_number": "360-681-8092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 EAST FRONT ST.",
            "address_2": "#2",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "98362",
            "telephone_number": "360-452-4432",
            "fax_number": "360-452-4599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLLALLAM COUSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-16",
        "last_updated": "2011-11-16",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-452-4432",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CB00017145"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "CP00004528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CP00004528",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; 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.