Individual provider Active NPI

Damia D Kelly, MHC

  • Mental Health Counselor
  • Clearwater, FL
National Provider Identifier
1164725404
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
1437 S Belcher Rd
Clearwater, FL 33764-2829
Phone
(727) 524-4464
Fax
(727) 524-4491
NPI assigned
Dec 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X CBHCMS100759 FL
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

1437 S Belcher Rd
Clearwater, FL 33764-2829

Mailing address

1437 S Belcher Rd
Clearwater, FL 33764-2829
Phone (727) 524-4464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CBHCMS100759FLMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1164725404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1437 S BELCHER RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337642829",
            "telephone_number": "727-524-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1437 S BELCHER RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337642829",
            "telephone_number": "727-524-4464",
            "fax_number": "727-524-4491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DAMIA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "MHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-08",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "CBHCMS100759",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.