Active NPI
Loren Wilburn McCollom, PH.D.
- Psychologist
- Tacoma, WA
National Provider Identifier
1881729002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY00001610
- Practice address
- 610 112TH St E
Tacoma, WA 98445-3002 - Phone
- (253) 537-2574
- Fax
- (253) 537-2283
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- 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 | PY00001610 | WA | Primary |
Addresses
Primary practice location
610 112TH St E
Tacoma, WA 98445-3002
Mailing address
610 112TH St E
Tacoma, WA 98445-3002
Phone (253) 537-2574
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 |
|---|---|---|---|
| PY00001610 | WA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881729002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 112TH ST E",
"city": "TACOMA",
"state": "WA",
"postal_code": "984453002",
"telephone_number": "253-537-2574",
"fax_number": "253-537-2283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 112TH ST E",
"city": "TACOMA",
"state": "WA",
"postal_code": "984453002",
"telephone_number": "253-537-2574",
"fax_number": "253-537-2283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOLLOM",
"first_name": "LOREN",
"middle_name": "WILBURN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY00001610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.