Active NPI
Candice Balluru, PH.D.
- Psychologist
- Lynnwood, WA
National Provider Identifier
1700219508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY60965267
- Practice address
- 16521 13TH Ave W Ste 210
Lynnwood, WA 98037-8511 - Phone
- (425) 243-2522
- NPI assigned
- Aug 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY60965267 | WA | Primary |
Addresses
Primary practice location
16521 13TH Ave W Ste 210
Lynnwood, WA 98037-8511
Mailing address
16232 Bothell Everett Hwy # 1038
Mill Creek, WA 98012-1520
Phone (425) 243-2522
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60965267 | WA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Flourish Counseling & Mental Wellness Center | 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 and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738022400000",
"number": "1700219508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16232 BOTHELL EVERETT HWY # 1038",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980121520",
"telephone_number": "425-243-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16521 13TH AVE W STE 210",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980378511",
"telephone_number": "425-243-2522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLURU",
"first_name": "CANDICE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-15",
"last_updated": "2025-01-28",
"certification_date": "2025-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY60965267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.