Active NPI
Kelly McCullough
- Addiction (Substance Use Disorder) Counselor
- Pasco, WA
National Provider Identifier
1417333873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CP60184864
- Practice address
- 715 W Court St
Pasco, WA 99301-4153 - Phone
- (509) 554-6506
- Fax
- (509) 546-0520
- NPI assigned
- Aug 7, 2015
- 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) Counselor | 101YA0400X | CP60184864 | WA | Primary |
Addresses
Primary practice location
715 W Court St
Pasco, WA 99301-4153
Mailing address
1707 W 34TH Ave
Kennewick, WA 99337-3838
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 |
|---|---|---|---|
| CP60184864 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539302400000",
"number": "1417333873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 W 34TH AVE",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993373838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 W COURT ST",
"city": "PASCO",
"state": "WA",
"postal_code": "993014153",
"telephone_number": "509-554-6506",
"fax_number": "509-546-0520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-07",
"last_updated": "2018-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CP60184864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasco, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.