Kelly Elizabeth Skore, BA, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60859062 Issued in WA

Practice address

12850 Lala Cove LN SE
Olalla, WA 98359-9664

Phone

(253) 857-6201

Fax

(253) 857-3993

NPI assigned

Sep 19, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Elizabeth Derring Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/olalla/r4/

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.

• Olalla Recovery Centers

  • Substance Abuse Rehabilitation Facility
  • Olalla, WA
  • NPI 1609984681
  NPD (past)

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1922582535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12850 LALA COVE LN SE",
            "city": "OLALLA",
            "state": "WA",
            "postal_code": "983599664",
            "telephone_number": "253-857-6201",
            "fax_number": "253-857-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12850 LALA COVE LN SE",
            "city": "OLALLA",
            "state": "WA",
            "postal_code": "983599664",
            "telephone_number": "253-857-6201",
            "fax_number": "253-857-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKORE",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "credential": "BA, CDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60859062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DERRING",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jena Yvonne Milo I
• Carmen L Morgan
• Olalla Recovery Centers
• Peper Owens-Brown, MSW, CDPT
• Glen Corey Pierson, R.PH.
• Justin Toulon, PT, DPT
• Lois West

• Addiction (Substance Use Disorder) Counselor in Olalla, WA
• Providers in Olalla, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; 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.