Paul Charles McCollum, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305758 Issued in MN

Practice address

10077 Dogwood St NW Ste 110
Coon Rapids, MN 55448-5285

Phone

(651) 777-5222

NPI assigned

Feb 6, 2023

Sex

Male

Sole proprietor

No

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.

• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)
• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  NPD (past)

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725667200000",
    "number": "1841996451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14300 34TH AVE N APT 338",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475207",
            "telephone_number": "716-380-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10077 DOGWOOD ST NW STE 110",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554485285",
            "telephone_number": "651-777-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "PAUL",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-06",
        "last_updated": "2024-09-07",
        "certification_date": "2024-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Mayer, MD
• Steffi Maynor
• MC Transportation Services LLC
• Jennifer McCarty
• Jessica McClure, PA-C
• McCormack Behavioral Health
• Carly Cristine McCormack, LADC, LPCC
• James Andrew McCoy, MD
• Jane McCrossen, RN CNP
• Elizabeth Anastasia McDevitt, PMNHP

• Addiction (Substance Use Disorder) Counselor in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2024; 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.