Kellie Gwaltney, MA, LMFT, LPC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT001506 Issued in GA

Practice address

2750 Old Alabama Rd
Suite 200
Johns Creek, GA 30022-8593

Phone

(678) 893-5300

Fax

(678) 893-5312

NPI assigned

Sep 7, 2006

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 14, 2024 through Mar 14, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• The Summit Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • Johns Creek, GA
  • NPI 1477761633
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1194829572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 OLD ALABAMA RD",
            "address_2": "SUITE 200",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300228593",
            "telephone_number": "678-893-5300",
            "fax_number": "678-893-5312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 OLD ALABAMA RD",
            "address_2": "SUITE 200",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300228593",
            "telephone_number": "678-893-5300",
            "fax_number": "678-893-5312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWALTNEY",
        "first_name": "KELLIE",
        "credential": "MA, LMFT, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-07",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008494",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT001506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura A Gullicksen, CRNA
• Jan Denise Gunn, P.A.-C.
• Vijayasudha Gunna, M.D.
• Edward Gurin, CPO
• Amanda Gustin, PT, DPT
• H&B Family Dental, LLC
• Sunyoung Ha
• Nicole Cristina Habibe Burgos, MD
• Mohammad Hajiha, MD, FRCSC UROLOGY
• Keianna S Haley, CNM

• Marriage & Family Therapist in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Marriage & Family Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.