The Juanita Center LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

31-1480-00 Issued in WA

Legal business name

THE JUANITA CENTER LLC

Practice address

627 5TH St
Suite 100a
Mukilteo, WA 98275-1580

Phone

(425) 328-9528

Fax

(425) 786-9276

NPI assigned

Aug 26, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Gary R McCullough, CDP, SAP, NCACNPI 1720256555

Title

Director

Phone

(425) 328-9528

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary R McCullough, CDP

  • Addiction (Substance Use Disorder) Counselor
  • Mukilteo, WA
  • NPI 1720256555
  NPD (past) Authorized official

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472256000000",
    "number": "1467908855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 5TH ST",
            "address_2": "SUITE 100A",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982751580",
            "telephone_number": "425-328-9528",
            "fax_number": "425-786-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 5TH ST",
            "address_2": "SUITE 100A",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982751580",
            "telephone_number": "425-328-9528",
            "fax_number": "425-786-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE JUANITA CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-27",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "425-328-9528",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CDP, SAP, NCAC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "31-1480-00",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Tat, NP
• Kristina Louise Taylor, MS, LMFT
• Madelaine Katrina Taylor, PHARM D
• Aspin Teevin, LMT
• The J. L. Donaldson Services Corp.
• Sarah Thome, RN
• Kathy Thompson, ATC
• Thrifty Payless Inc
• Raquel Marie Tingey, ND
• Andrew O Todd, DO

• Substance Use Disorder Rehabilitation Clinic/Center in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2016; 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.