Individual provider Active NPI

Kelly Grace McCoy

  • Professional Counselor
  • Medford, OR
National Provider Identifier
1225702350
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C9969 Issued in OR
Practice address
200 Beatty St
Medford, OR 97501-5811
Phone
(541) 476-2373
NPI assigned
Aug 3, 2021
Last updated
Jun 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X C9969 OR Primary

Addresses

Primary practice location

200 Beatty St
Medford, OR 97501-5811

Mailing address

1215 SW G St
Grants Pass, OR 97526-2544
Phone (541) 476-2373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20250617001179 OR Practitioner - Mental Health Counselor 8224549217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Options for Southern OregonGroup PAC ID 0941202006, 70 clinicians

Practice addresses (Care Compare)

1644 Carnahan Dr
Grants Pass, OR 97527-4724
Phone (541) 471-6363

200 Beatty St
Medford, OR 97501-5811
Phone (541) 476-2373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C9969ORMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Options for Southern Oregon CurrentSince May 14, 2025 Accepting new patients
Options for Southern Oregon CurrentSince May 14, 2025 Accepting new patients

Locations

1215 SW G St
Grants Pass, OR 97526
Phone (541) 244-4109

200 Beatty St
Medford, OR 97501
Phone (541) 774-4812

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1225702350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW G ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262544",
            "telephone_number": "541-476-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BEATTY ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015811",
            "telephone_number": "541-476-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "KELLY",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C9969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.