Kelly Mark, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY60781335 Issued in WA

Practice address

330 112TH Ave NE Ste 302
Bellevue, WA 98004

Phone

(206) 853-2409

NPI assigned

Sep 27, 2012

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 5, 2019 through Jan 5, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1043561285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 121ST AVE SE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980062827",
            "telephone_number": "062-853-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 112TH AVE NE STE 302",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98004",
            "telephone_number": "206-853-2409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 E Compton Blvd",
            "address_purpose": "LOCATION",
            "city": "Compton",
            "state": "CA",
            "postal_code": "902213303",
            "country_code": "US",
            "telephone_number": "310-668-6931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24909 104th Ave SE Ste 101A",
            "address_purpose": "LOCATION",
            "city": "Kent",
            "state": "WA",
            "postal_code": "980302819",
            "country_code": "US",
            "telephone_number": "206-853-2409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARK",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-27",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60781335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hadley Maris, MA
• Mark H Cohn, OD, PS
• Mark Harrington Associates
• Mark L Dire DDS P.S.
• Mark Lockwood, D.C.
• Lawrence Mark, LMFT
• Amy Jane Markezich, MD
• Kendra Lian Marks, AU.D.
• Stephen Peter Markus, MD
• Marianne E Marlow, MA

• Psychologist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.