Kelly L Nicholson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1340 Issued in SC

Practice address

1605 Moonstone LN
Castle Rock, CO 80108-7809

Phone

(720) 588-6772

NPI assigned

May 10, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelly L Nicholson, PSYD

  • Clinical Psychologist
  • Hilton Head Island, SC
  • NPI 1285001560
  Medicare reassignment NPD Authorized official
• Psychological and Counseling Center

  • Adult Health Nurse Practitioner
  • Bluffton, SC
  • NPI 1437697224
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440115200000",
    "number": "1043424807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 REDBUD WAY",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299105605",
            "telephone_number": "843-226-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 MOONSTONE LN",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801087809",
            "telephone_number": "720-588-6772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "KELLY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-10",
        "last_updated": "2015-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "3154",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "1340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Paradigm Counseling Education Foundation
• Russell Roy Newlin, RPH
• Next Era Physical Therapy Castle Rock, PC
• Jacob Hiep Nguyen, DENTAL HYGIENIST
• Kelly Nichols, MSLAC
• Mallory Lynn Nicklas, LSW
• Kalen Niedling, M.A., CCC-SLP
• Morgan Niemann
• No Limits PT, LLC
• Jeffrey Nollen

• Clinical Psychologist in Castle Rock, CO
• Providers in Castle Rock, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.