Brian Lee Kelley, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180007807 Issued in IL

Practice address

3317 W 95TH St
Evergreen Park, IL 60805-2243

Phone

(708) 529-3011

NPI assigned

Oct 11, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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 and National Provider Directory roles.

• Southside Christian Counseling Center

  • Professional Counselor
  • Tinley Park, IL
  • NPI 1861790883
  NPD (past)

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611446400000",
    "number": "1003191990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10S141 SUFFIELD DR",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605165184",
            "telephone_number": "773-316-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052243",
            "telephone_number": "708-529-3011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16547 Oak Park Ave",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604771752",
            "country_code": "US",
            "telephone_number": "708-633-9003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "BRIAN",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-11",
        "last_updated": "2021-01-24",
        "certification_date": "2021-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180007807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Terry Katz, O.D.
• Brenna Keaty, DPT
• Kedzie Medical Associates LTD
• Kedzie Medical Associates,LTD
• Michelle Marie Keller
• Leslie Kelly, FNP-BC
• Margaret Kelly, LCPC
• Richard D. Kern, M.D.
• Melodie Keshani, DO
• Kevin Oliver Zweig MD SC

• Professional Counselor in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2021; 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.