Teresa Lee Brunelle, CDPT | NPI 1922564962

Key facts

NPI: 1922564962
Entity type: Individual (NPI type 1)
Primary specialty: Addiction (Substance Use Disorder) Counselor 101YA0400X
License: 60730867 (WA)
Practice address: 404 W Main St
Kelso, WA 98626-1118
Phone: (360) 423-2806
NPI assigned: Feb 14, 2019
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Awakenings, Inc Addiction (Substance Use Disorder) Counselor · Kelso, WA · NPI 1275245722

NPD (past) ADDICTION (SUBSTANCE USE DISORDER)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
60730867	WA	MD	Addiction (Substance Use Disorder) Counselor

Practice roles

Organization	Specialty	Status	New patients
Awakenings, Inc	Addiction (Substance Use Disorder)	Past since Dec 18, 2022	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Addiction (Substance Use Disorder) Counselor	101YA0400X	60730867	WA	Yes

Addresses

Primary practice location

404 W Main St
Kelso, WA 98626-1118

Mailing address

311 W Kingsbury Rd
Kelso, WA 98626-9523
Phone (360) 560-8826

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 14, 2019.

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550102400000",
    "number": "1922564962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W KINGSBURY RD",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986269523",
            "telephone_number": "360-560-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W MAIN ST",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986261118",
            "telephone_number": "360-423-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNELLE",
        "first_name": "TERESA",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "CDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-14",
        "last_updated": "2019-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60730867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kelso, WA

All providers in Kelso, WA · Addiction (Substance Use Disorder) Counselor in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.