Active NPI
Shirley Kelley
- Counselor
- Texarkana, TX
National Provider Identifier
1104138015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 64202
- Practice address
- 1125 N Robison Rd
Texarkana, TX 75501-4103 - Phone
- (903) 832-2860
- Fax
- (903) 832-2870
- NPI assigned
- Jul 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 64202 | TX | Primary |
Addresses
Primary practice location
1125 N Robison Rd
Texarkana, TX 75501-4103
Mailing address
1125 N Robison Rd
Texarkana, TX 75501-4103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240402003524 | TX | Practitioner - Mental Health Counselor | 9436597085 | Practice locations: Texarkana, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Texas a & M University System, HSC, College of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4152 McKnight Rd
Texarkana, TX 75503-0921
Phone (903) 831-1050
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1104138015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 N ROBISON RD",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755014103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 N ROBISON RD",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755014103",
"telephone_number": "903-832-2860",
"fax_number": "903-832-2870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SHIRLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-08",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "64202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.