Kenneth McCullough, LADC, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC1102 Issued in ME

Practice address

52 Water St
Suite 2
Hallowell, ME 04347

Phone

(207) 430-3777

Fax

(207) 621-4020

NPI assigned

Feb 3, 2012

Last updated

Dec 7, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Protea Integrated Health and Wellness, LLC

  • Community/Behavioral Health Agency
  • Hallowell, ME
  • NPI 1083028765
  NPD (past)

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

{
    "created_epoch": "1328227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449446400000",
    "number": "1902178080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 WATER ST",
            "address_2": "SUITE 2",
            "city": "HALLOWELL",
            "state": "ME",
            "postal_code": "04347",
            "telephone_number": "207-430-3777",
            "fax_number": "207-621-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 WATER ST",
            "address_2": "SUITE 2",
            "city": "HALLOWELL",
            "state": "ME",
            "postal_code": "04347",
            "telephone_number": "207-430-3777",
            "fax_number": "207-621-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KENNETH",
        "credential": "LADC, LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-03",
        "last_updated": "2015-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC197",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ME",
            "license": "CC1102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Murphy, LCSW Counseling Services, LLC
• Todd C Macfarlane, LCPC
• Maine School Administrative District #16 (Msad #16)
• Dean Martin, LCPC LADC
• Stephanie M Martyak, DO
• John Daniel Merrill, MSW
• Michael J Migliore, RPH., MS, LAC.
• Robert Mulliken, LCSW
• Nathan Richard Murray-James, MD
• New England Sleep Solutions LLC

• Mental Health Counselor in Hallowell, ME
• Providers in Hallowell, ME by specialty
• Mental Health Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; 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.