Kalen Kelly, LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

16942 Issued in SC

Practice address

61 Riverwalk Blvd Ste H
Ridgeland, SC 29936-3252

Phone

(843) 636-5017

Fax

(843) 206-0256

NPI assigned

Jan 16, 2023

Last updated

May 23, 2024By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

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.

• Bluffton Okatie Counseling Center, LLC

  • Clinical Social Worker
  • Ridgeland, SC
  • NPI 1225544562
  Medicare reassignment NPD
• South Carolina Online Counseling and Group Therapy, LLC

  • Professional Counselor
  • Ridgeland, SC
  • NPI 1154928448
  NPD

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1225743149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 RIVERWALK BLVD STE H",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299363252",
            "telephone_number": "843-636-5017",
            "fax_number": "843-206-0256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 RIVERWALK BLVD STE H",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299363252",
            "telephone_number": "843-636-5017",
            "fax_number": "843-206-0256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "149 Riverwalk Blvd Ste 10",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "SC",
            "postal_code": "299368191",
            "country_code": "US",
            "telephone_number": "843-636-5017",
            "fax_number": "843-206-0256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KALEN",
        "credential": "LISW-CP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "16942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.blufftonokatiecc.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "TherapyNotes",
            "address_1": "61 Riverwalk Blvd",
            "address_2": "Ste H",
            "city": "RIDGELAND",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29936",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Tequila King, PTA
• Kings of Cbe LLC Dba Edna's Transportation Services (Edna's Transportation Service)
• Joshua Earl Knight, DPT, PT
• Kristen Nicole Kobylarz, BCABA

• Clinical Social Worker in Ridgeland, SC
• Providers in Ridgeland, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.

Verify at the official NPI Registry.