NPIMap

Organization Active NPI

Kelly Carlson, LLC

Doing business as Kelly Lyn Carlson, LMHC

  • Community/Behavioral Health Agency
  • Jupiter, FL
National Provider Identifier
1124468764
Registry record updated Jun 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MH8729 Issued in FL
Legal business name
KELLY CARLSON, LLC
Doing business as
Kelly Lyn Carlson, LMHC
Practice address
5500 Military TRL
#22-106
Jupiter, FL 33458-2869
Phone
(561) 354-8795
Fax
(561) 743-7165
NPI assigned
Jun 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2013

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

Authorized official

Name
Kelly L Carlson, LMHCNPI 1720326408
Title
Owner
Phone
(561) 354-8795

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MH8729 FL Primary

Addresses

Primary practice location

5500 Military TRL
#22-106
Jupiter, FL 33458-2869

Mailing address

5500 Military TRL
#22-106
Jupiter, FL 33458-2869
Phone (561) 354-8795

Other names 1

  • Kelly Lyn Carlson, LMHC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kelly Carlson LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372291200000",
    "number": "1124468764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MILITARY TRL",
            "address_2": "#22-106",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334582869",
            "telephone_number": "561-354-8795",
            "fax_number": "561-743-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 MILITARY TRL",
            "address_2": "#22-106",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334582869",
            "telephone_number": "561-354-8795",
            "fax_number": "561-743-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY CARLSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-354-8795",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MH8729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly Lyn Carlson, LMHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jupiter, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.