NPIMap

Organization Active NPI

Kelly a. Ellis

  • Clinical Social Worker
  • Palm Desert, CA
National Provider Identifier
1053793216
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
16686 Issued in CA
Legal business name
KELLY A. ELLIS
Doing business as
Counseling & Wellness Center
Practice address
39760 Black Mesa LN
Palm Desert, CA 92260-1501
Phone
(760) 832-4904
NPI assigned
Jun 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Ms. Kelly A Ellis, LCSW
Title
Owner
Phone
(760) 832-4904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 16686 CA Primary

Addresses

Primary practice location

39760 Black Mesa LN
Palm Desert, CA 92260-1501

Mailing address

PO Box 2805
Rancho Mirage, CA 92270-1099
Phone (760) 832-4904

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ28136ZOtherCAMEDICARE PTAN

Other names 1

  • Counseling & Wellness Center Doing business as

National Provider Directory

National Provider Directory

Locations

42900 Bob Hope Dr
Ste 104
Rancho Mirage, CA 92270
Phone (760) 346-0606

41750 Rancho Las Palmas Dr
Ste K-1
Rancho Mirage, CA 92270
Phone (323) 363-9237

41750 Rancho Las Palmas Dr
Ste D2
Rancho Mirage, CA 92270
Phone (760) 832-4904

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1053793216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2805",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701099",
            "telephone_number": "760-832-4904",
            "fax_number": "760-300-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39760 BLACK MESA LN",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922601501",
            "telephone_number": "760-832-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY A. ELLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-832-4904",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "16686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ28136Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Counseling & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Counseling & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.