Active NPI
Antonio Kallungal
- Mental Health Counselor
- Gaithersburg, MD
National Provider Identifier
1821799388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 0704014134
- Practice address
- 18317 Winter Park CT
Gaithersburg, MD 20879-4626 - Phone
- (703) 705-2476
- NPI assigned
- Mar 13, 2023
- Last updated
- Mar 13, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0704014134 | VA | Primary |
Addresses
Primary practice location
18317 Winter Park CT
Gaithersburg, MD 20879-4626
Mailing address
18317 Winter Park CT
Gaithersburg, MD 20879-4626
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0704014134 | VA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678665600000",
"number": "1821799388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18317 WINTER PARK CT",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "208794626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18317 WINTER PARK CT",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "208794626",
"telephone_number": "703-705-2476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLUNGAL",
"first_name": "ANTONIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-13",
"last_updated": "2023-03-13",
"certification_date": "2023-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VA",
"license": "0704014134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gaithersburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.