Provider Demographics
NPI:1508564832
Name:MCCOLLOUGH, KEVIN DARBY (MA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DARBY
Last Name:MCCOLLOUGH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 N NAVARRO ST STE 300C
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1770
Mailing Address - Country:US
Mailing Address - Phone:361-571-0381
Mailing Address - Fax:
Practice Address - Street 1:5606 N NAVARRO ST STE 300C
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1770
Practice Address - Country:US
Practice Address - Phone:361-571-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46106101YA0400X
TX16500101YA0400X
TX90886101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health