Kelly Van Moen, MS, LLPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401015525 Issued in MI

Practice address

124 W Gates St
Suite 103
Bruce TWP, MI 48065-4494

Phone

(586) 752-6969

NPI assigned

Jul 12, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Macomb Family Services IncGroup PAC ID 5193700888, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/macombfamily/r4/

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.

• Macomb Family Services, Inc.

  • Clinical Social Worker
  • Clinton Township, MI
  • NPI 1831190701
  Medicare reassignment Care Compare group NPD
• Macomb Family Services, Inc

  • Clinical Social Worker
  • Clinton Township, MI
  • NPI 1326599036

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468281600000",
    "number": "1134571219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 W GATES ST",
            "address_2": "SUITE 103",
            "city": "BRUCE TWP",
            "state": "MI",
            "postal_code": "480654494",
            "telephone_number": "586-752-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W GATES ST",
            "address_2": "SUITE 103",
            "city": "BRUCE TWP",
            "state": "MI",
            "postal_code": "480654494",
            "telephone_number": "586-752-6969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN MOEN",
        "first_name": "KELLY",
        "credential": "MS, LLPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6401015525",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401015525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Kay Smith, LMSW
• Maddison K Smith, FNP-BC
• Deborah Ann Stys, MS
• Joanne Marie Talarek, RN, MSN, C-ANP
• Katilyn Thomas

• Mental Health Counselor in Bruce TWP, MI
• Providers in Bruce TWP, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; 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.

Verify at the official NPI Registry.