Matthew Brian Kelley, M.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

T-0124261 Issued in NM

Practice address

8600 Academy Rd NE
Albuquerque, NM 87111-1107

Phone

(505) 821-3628

Fax

(505) 856-7103

NPI assigned

Jul 15, 2009

Sex

Male

Sole proprietor

No

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.

• Formation Counseling Services Inc

  • Community/Behavioral Health Agency
  • Albuquerque, NM
  • NPI 1033274535
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 15, 2009.

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247616000000",
    "number": "1124258918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 ACADEMY RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871111107",
            "telephone_number": "505-821-3628",
            "fax_number": "505-856-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 ACADEMY RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871111107",
            "telephone_number": "505-821-3628",
            "fax_number": "505-856-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MATTHEW",
        "middle_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-15",
        "last_updated": "2009-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "T-0124261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen C Keller, PA-C
• Evoanna Kileen Kelley Correa, LCSW
• Gretchen Marie Kelley, DDS
• Isabella Kelley
• Jonathan Harper Kelley, DDS
• Naomi Kelley, MD
• Ray Kelley, MD
• Tania Kelley
• Kara Kellogg, L.I.S.W.
• Riannah Kellogg

• All providers in Albuquerque, NM
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; 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.