Kelly Robinson Green, MC, LPC, LISAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-11799 Issued in AZ

Practice address

5701 W Talavi Blvd Ste 180
Glendale, AZ 85306-1888

Phone

(623) 687-2865

Fax

(623) 486-2739

NPI assigned

May 30, 2011

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 AZ

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/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.

• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1023174455
  Medicare reassignment NPD
• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1609939214
  NPD
• Jewish Family & Children'S Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1467520577
  NPD (past)

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

{
    "created_epoch": "1306713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1144514811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 N 7TH ST STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850143654",
            "telephone_number": "602-279-7655",
            "fax_number": "602-680-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 W TALAVI BLVD STE 180",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061888",
            "telephone_number": "623-687-2865",
            "fax_number": "623-486-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KELLY",
        "middle_name": "ROBINSON",
        "name_prefix": "Mrs.",
        "credential": "MC, LPC, LISAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-30",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-1345",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-11799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Apple Kids Therapy LLC
• Green Heron Senior Living, Inc.
• Amy Jo Green, PSY. S
• Frederick Chapman Green Jr., M.D.
• Kara Green, MSN, FNP-BC
• Marshea T Green
• Steven Green, D.D.S.
• Teri Green, LCSW
• Tirzah Green
• Leighanna Greene

• Professional Counselor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.