Sally McCollum, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 237 Issued in ID

Practice address

171 W. 1St St #1
Ketchum, ID 83340-6078

Phone

(208) 726-8926

Fax

(208) 726-8926

NPI assigned

Aug 25, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Frank Andrews, PH.D. PA

  • Clinical Psychologist
  • Hailey, ID
  • NPI 1730410986
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421193600000",
    "number": "1609984210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6078",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833406078",
            "telephone_number": "208-726-8926",
            "fax_number": "208-726-8926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 W. 1ST ST #1",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833406078",
            "telephone_number": "208-726-8926",
            "fax_number": "208-726-8926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "SALLY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2015-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY 237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria M Maricich, D.C.
• Kara Maxwell, L.AC
• Chris Michael Mazzola, DDS
• Royal McClure, MD
• Lorena McClusky, RPH
• Nancy Theresa McDonnell-Penrose, PT
• Pierson Scott McLean Jr., M.D.
• Kevin Wright McMinn, D.M.D, M.S.D
• Meier Clinics of California
• Meier Clinics of California, Inc.

• Clinical Psychologist in Ketchum, ID
• Providers in Ketchum, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.