Kim Ellen, M.A., L.P.C.

Primary specialty

CounselorTaxonomy code 101Y00000X

License

6401009255 Issued in MI

Practice address

615 Shipyard Blvd
Wilmington, NC 28412-6431

Phone

(910) 343-0145

NPI assigned

Oct 17, 2007

Last updated

Dec 16, 2009By the provider in NPPES

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 NC

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, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chrysalis Center for Counseling and Eating Disorder Treatment PLLC

  • Psychologist
  • Wilmington, NC
  • NPI 1891865218
  Medicare reassignment NPD

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1205025079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2563 CROQUET DR UNIT 7",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284125179",
            "telephone_number": "910-338-8251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLEN",
        "first_name": "KIM",
        "name_prefix": "Ms.",
        "credential": "M.A., L.P.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-17",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401009255",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "7567",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elevate Speech Therapy & Coaching PLLC
• Christina Sue Elicson, PA-C
• Elite Chiropractic
• Elizabeth Hartman
• Ella Deaver Counseling and Psychotherapy
• Joseph William Ellender IV, PA-C
• Eloise Natalie Eller, LCSW, CEAP
• Joshua Nicholas Ellerbrock, DNP, FNP
• Paige Ellington
• Raymond Bradford Kevin Elliott, PHARMD

• Counselor in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.