Active NPI
Mark Allen Kelly, P-LPC
- Counselor
- Oxford, MS
National Provider Identifier
1104708437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 2094 Old Taylor Rd Ste 157
Oxford, MS 38655-5019 - Phone
- (601) 790-0583
- NPI assigned
- Jul 25, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 | MS | Primary |
Addresses
Primary practice location
2094 Old Taylor Rd Ste 157
Oxford, MS 38655-5019
Mailing address
2094 Old Taylor Rd Ste 157
Oxford, MS 38655-5019
Phone (601) 790-0583
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeworks Counseling | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Madison, MS
- NPI 1124471412
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753401600000",
"number": "1104708437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2094 OLD TAYLOR RD STE 157",
"city": "OXFORD",
"state": "MS",
"postal_code": "386555019",
"telephone_number": "601-790-0583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2094 OLD TAYLOR RD STE 157",
"city": "OXFORD",
"state": "MS",
"postal_code": "386555019",
"telephone_number": "601-790-0583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MARK",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "P-LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-25",
"last_updated": "2025-07-25",
"certification_date": "2025-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MS",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxford, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.