Active NPI
Darwin Ray Kellicut, MSW
- Marriage & Family Therapist
- Coeur d'Alene, ID
National Provider Identifier
1417965781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LF00001127
- Practice address
- 1420 Lincoln Way Ste 500
Coeur D Alene, ID 83814-2391 - Phone
- (208) 667-8474
- Fax
- (208) 665-5704
- NPI assigned
- Aug 3, 2006
- Last updated
- Sep 11, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW 179 | ID | |
| Clinical Social Worker | 1041C0700X | LW00004911 | WA | |
| Marriage & Family Therapist | 106H00000X | LMFT 3089 | ID | |
| Marriage & Family Therapist | 106H00000X | LF00001127 | WA | Primary |
Addresses
Primary practice location
1420 Lincoln Way Ste 500
Coeur D Alene, ID 83814-2391
Mailing address
1420 Lincoln Way Ste 500
Coeur D Alene, ID 83814-2391
Phone (208) 667-8474
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 |
|---|---|---|---|
| LCSW 179 | ID | MD | Clinical Social Worker |
| LW00004911 | WA | MD | Clinical Social Worker |
| LMFT 3089 | ID | MD | Marriage & Family Therapist |
| LF00001127 | WA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poignant Possibilities, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1417965781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 LINCOLN WAY STE 500",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142391",
"telephone_number": "208-667-8474",
"fax_number": "208-665-5704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 LINCOLN WAY STE 500",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142391",
"telephone_number": "208-667-8474",
"fax_number": "208-665-5704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLICUT",
"first_name": "DARWIN",
"middle_name": "RAY",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW 179",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW00004911",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "ID",
"license": "LMFT 3089",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WA",
"license": "LF00001127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur d'Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.