Kelly M. Altic, MSW, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I0070239-SUPV Issued in OH

Practice address

670 Meridian Way Ste 225
Westerville, OH 43082-2304

Phone

(614) 974-9808

NPI assigned

Jul 31, 2006

Last updated

Apr 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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 Altic Lisw-S Counseling LLC

  dba Healthy Self Counseling

  • Clinical Social Worker
  • Westerville, OH
  • NPI 1043891898
  Authorized official Same address or phone
• Center for Cognitive Behavioral Therapy of Greater Columbus Inc

  • Psychologist
  • Columbus, OH
  • NPI 1548201262
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1083620850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MERIDIAN WAY STE 225",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430822304",
            "telephone_number": "614-974-9808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 MERIDIAN WAY STE 225",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430822304",
            "telephone_number": "614-974-9808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTIC",
        "first_name": "KELLY",
        "middle_name": "M.",
        "credential": "MSW, LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0070239-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0324160",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellyaltic@counselingsecure.com",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "670 Meridian Way Ste 225",
            "city": "Westerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430822304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Lacey Janelle Althausen, MD
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• Olivia Alzuraigat
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• Alpha Mohamed Amara
• Mabinti Amara

• Clinical Social Worker in Westerville, OH
• Providers in Westerville, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; 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.