Kelly Williams

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.190764 Issued in OH

Practice address

2775 State Route 39
Shelby, OH 44875-9466

Phone

(419) 747-3322

NPI assigned

Jan 6, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Cornell Abraxas Group, LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Shelby, OH
  • NPI 1376518902
  NPD (past)

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

{
    "created_epoch": "1736121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1245049188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1374 GREENFIELD AVE SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447065464",
            "telephone_number": "954-678-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 STATE ROUTE 39",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448759466",
            "telephone_number": "419-747-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.190764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ralph Fredrick Westerfield Jr.
• Jordan Wheeler, LPN
• Hollie Wiggins
• Dixie Lee Wilcox
• Matthew Wilging, PT, DPT
• Laurie Jane Williams
• Samantha Williams
• Alexis Wilson
• Scott Wilson, LPC, CDCA
• Winbigler & Zitko Optometrists, LTD.

• Addiction (Substance Use Disorder) Counselor in Shelby, OH
• Providers in Shelby, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.