Individual provider Active NPI

Kelsey Manley

  • Mental Health Counselor
  • Santa Rosa, CA
National Provider Identifier
1245695873
Registry record updated Dec 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
634 Pressley St
Santa Rosa, CA 95404-5526
Phone
(707) 573-6955
NPI assigned
Dec 26, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

634 Pressley St
Santa Rosa, CA 95404-5526

Mailing address

6742 Round Oak Rd
Penngrove, CA 94951-9753
Phone (707) 483-0775

Other identifiers 1

IdentifierTypeStateIssuer
2244OtherCAMEDICAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1451088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451088000000",
    "number": "1245695873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6742 ROUND OAK RD",
            "city": "PENNGROVE",
            "state": "CA",
            "postal_code": "949519753",
            "telephone_number": "707-483-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 PRESSLEY ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045526",
            "telephone_number": "707-573-6955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANLEY",
        "first_name": "KELSEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-26",
        "last_updated": "2015-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "2244",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2015; 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.