Active NPI
Mike Kelly
- Behavior Technician
- Carmel, IN
National Provider Identifier
1013521756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1081 3Rd Ave SW Ste 7
Carmel, IN 46032-7500 - Phone
- (317) 564-0934
- NPI assigned
- Sep 1, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1081 3Rd Ave SW Ste 7
Carmel, IN 46032-7500
Mailing address
1389 W 86TH St # 170
Indianapolis, IN 46260-2101
Phone (317) 250-1744
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Dropbox.com | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse Behavioral Services, LLC | Current | Accepting new patients |
Locations
1081 3rd Ave SW
Ste 7
Carmel, IN 46032
Phone (317) 564-0934
1389 W 86th St
Indianapolis, IN 46260
Phone (317) 409-6151
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.
-
- Behavior Analyst
- Carmel, IN
- NPI 1598186363
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1013521756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1389 W 86TH ST # 170",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462602101",
"telephone_number": "317-250-1744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1081 3RD AVE SW STE 7",
"city": "CARMEL",
"state": "IN",
"postal_code": "460327500",
"telephone_number": "317-564-0934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MIKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-01",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Dropbox.com",
"affiliation": "N",
"endpointDescription": "File Storage",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "File Storage",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Documents",
"address_1": "1081 3rd Ave SW Ste 7",
"city": "Carmel",
"state": "IN",
"country_code": "US",
"postal_code": "460327500",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.