Gary R McCullough, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00001723 Issued in WA

Practice address

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

Phone

(425) 290-5757

Fax

(425) 786-9276

NPI assigned

Feb 14, 2008

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

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.

• The Juanita Center LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Mukilteo, WA
  • NPI 1467908855
  NPD (past) Authorized official

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1720256555",
    "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": "425-290-5757",
            "fax_number": "425-786-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "GARY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-14",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00001723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beatris Martinez, ATC
• Mastery Mental Health PLLC
• Julie Maxim
• Jennifer N Mbugua
• Peggyanne McCasland X, AFFILIATED COUNSELOR
• Ian McEwen, LMT
• Jason McIver
• Robert McKnight, MD
• Tammy McLendon, LMP
• Edwin Melendez II Jr.

• Addiction (Substance Use Disorder) Counselor in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.