Individual provider Active NPI

Kahlin Kelly

  • Professional Counselor
  • Springfield, OH
National Provider Identifier
1083020259
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.1700205 Issued in OH
Practice address
474 N Yellow Springs St
Springfield, OH 45504-2463
Phone
(937) 399-9500
NPI assigned
Jul 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C1300595 OH
Professional Counselor 101YP2500X E.1700205 OH Primary

Addresses

Primary practice location

474 N Yellow Springs St
Springfield, OH 45504-2463

Mailing address

474 N Yellow Springs St
Springfield, OH 45504-2463
Phone (614) 355-8004

Other practice location 1

399 E Main St
Columbus, OH 43215-5384
Phone (614) 355-8550

Other identifiers 1

IdentifierTypeStateIssuer
2846675MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20240909000401 OH Practitioner - Mental Health Counselor 9830639665 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C1300595OHMDMental Health Counselor
E.1700205OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Services for Clark Co Inc CurrentSince Feb 3, 2025 Accepting new patients
Mental Health Services for Clark Co Inc CurrentSince Feb 3, 2025 Accepting new patients
Am Behavioral Outpatient LLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

210 N Main St
London, OH 43140
Phone (740) 845-7343

474 N Yellow Springs St
Springfield, OH 45504
Phone (937) 399-9500

2501 E High St
Springfield, OH 45505
Phone (937) 328-8700

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1083020259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 N YELLOW SPRINGS ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042463",
            "telephone_number": "614-355-8004",
            "fax_number": "614-355-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 N YELLOW SPRINGS ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042463",
            "telephone_number": "937-399-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "399 E Main St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432155384",
            "country_code": "US",
            "telephone_number": "614-355-8550",
            "fax_number": "614-355-8593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KAHLIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-08",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C1300595",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1700205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2846675",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.