Kelly A Ellis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW.0992416 Issued in CO

Practice address

39760 Black Mesa LN
Palm Desert, CA 92260

Phone

(760) 832-4904

NPI assigned

Jul 11, 2006

Last updated

Aug 1, 2023By the provider in NPPES

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

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 Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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 a. Ellis

  dba Counseling & Wellness Center

  • Clinical Social Worker
  • Palm Desert, CA
  • NPI 1053793216
  Authorized official Same address or phone

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1073548186",
    "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": "922702805",
            "telephone_number": "760-832-4904"
        },
        {
            "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": "92260",
            "telephone_number": "760-832-4904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42222 Rancho Las Palmas Dr #2805",
            "address_2": "Telehealth",
            "address_purpose": "LOCATION",
            "city": "Rancho Mirage",
            "state": "CA",
            "postal_code": "92270",
            "country_code": "US",
            "telephone_number": "760-832-4904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 16686",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.0992416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Akeimo Maatifa Eleasaro Jr.
• Bassmala Elgamal
• Elite Mobility Service LLC
• Sydnie Marie Elliott
• Brittany Michelle Ellis, DPT
• Zachary Brygart Ellison
• Ember and Bloom Marriage and Family Therapy Professional Corporation
• Emmanuel Pharmacy Corp.
• Empire Physicians Medical Group
• Empowered to Achieve

• Clinical Social Worker in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Clinical Social Worker in California

• 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.
• 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.