Kavya Reddy Mudiam, PHD

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Practice address

660 Bannock St
Denver, CO 80204-4506

Phone

(615) 663-0773

NPI assigned

Nov 2, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1467283069
  NPD
• Oslc Developments, Inc. - Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eugene, OR
  • NPI 1326433012
  NPD (past)
• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1508521733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SERENITY LN",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "974089350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 BANNOCK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044506",
            "telephone_number": "615-663-0773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Serenity Ln",
            "address_purpose": "LOCATION",
            "city": "Coburg",
            "state": "OR",
            "postal_code": "974089350",
            "country_code": "US",
            "telephone_number": "615-663-0773",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Shelton McMurphey Blvd",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974014928",
            "country_code": "US",
            "telephone_number": "541-485-2711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUDIAM",
        "first_name": "KAVYA",
        "middle_name": "REDDY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-02",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "21-QMHA-R-1774",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omar Asa'Ad Mubarak, MD
• Risa Muchnick, M.A.
• Stephen K Muckleroy, MD
• Sini Muckom, PHARM D
• Ahmed Mudey, PHARM.D
• Angela Eileen Mueller, PT, DPT
• Birgitta H Mueller, PT
• Charles Michael Mueller, LCSW
• Cynthia Gayle Mueller, MS, CNM
• Ferdinand Joseph Mueller Jr., M.D.

• Addiction (Substance Use Disorder) Psychologist in Denver, CO
• Providers in Denver, CO by specialty
• Addiction (Substance Use Disorder) Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; 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.