Kelly Ann Thompson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

51198 Issued in TX

Practice address

7111 Bosque Blvd
Waco, TX 76710-4002

Phone

(512) 686-6012

Fax

(512) 842-7227

NPI assigned

Jun 4, 2016

Last updated

Aug 28, 2017By 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

Other names 1

• Kelly Ann Clines Former name

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.

• New Leaf Counseling, Inc.

  • Clinical Social Worker
  • Austin, TX
  • NPI 1336310754
  NPD (past)

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

{
    "created_epoch": "1464998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503878400000",
    "number": "1093164618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 W MLK JR BLVD # 148",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787011231",
            "telephone_number": "512-686-6012",
            "fax_number": "512-842-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7111 BOSQUE BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104002",
            "telephone_number": "512-686-6012",
            "fax_number": "512-842-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-04",
        "last_updated": "2017-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "51198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "369408501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CLINES",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shelby Elizabeth Thomas, PA-C
• Chad M Thompson, MD
• Christopher Noel Thompson, M.D.
• Gaylon Wayne Thompson, LPC
• Janelle M Thompson, CRNA
• Natali Cristina Thornburg, PA-C
• Leslie Thrall, RD, LD
• Michael Thrasher, DDS
• Robert D Thrift, ED.D
• Thrive Wellness of Texas PLLC

• Clinical Social Worker in Waco, TX
• Providers in Waco, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2017; 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.