Active NPI
Halldis Kelly, PHD, LPC
- Professional Counselor
- Fort Collins, CO
National Provider Identifier
1164551560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2414
- Practice address
- 109 W Olive St
Fort Collins, CO 80524-2831 - Phone
- (970) 646-0151
- NPI assigned
- Mar 4, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2414 | CO | Primary |
Addresses
Primary practice location
109 W Olive St
Fort Collins, CO 80524-2831
Mailing address
3070 Tabernash Dr
Loveland, CO 80538-2486
Phone (970) 646-0151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240705000218 | CO | Practitioner - Mental Health Counselor | 4385188036 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2414 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Professional | Current | Accepting new patients |
Locations
720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423440000000",
"number": "1164551560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3070 TABERNASH DR",
"city": "LOVELAND",
"state": "CO",
"postal_code": "805382486",
"telephone_number": "970-646-0151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 W OLIVE ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242831",
"telephone_number": "970-646-0151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "HALLDIS",
"name_prefix": "Dr.",
"credential": "PHD, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-04",
"last_updated": "2015-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "2414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; 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.