Individual provider Active NPI

Amy Kelley, LPC

  • Professional Counselor
  • Lake City, FL
National Provider Identifier
1275870388
Registry record updated Feb 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0013812 Issued in CO
Practice address
175 SE Apache Way
Lake City, FL 32025-1723
Phone
(407) 493-0656
NPI assigned
Jan 9, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2026

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 LPC.0013812 CO Primary

Addresses

Primary practice location

175 SE Apache Way
Lake City, FL 32025-1723

Mailing address

630 Kingsley Ave
Orange Park, FL 32073-5465
Phone (904) 337-9040

Other names 1

  • Amy Schaet Former name

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

State licenses

LicenseStateTypeSpecialty
LPC.0013812COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wildly Authentic Counseling, LLC Professional CurrentSince Aug 1, 2021 Accepting new patients

Locations

12443 San Jose Blvd
Ste 202
Jacksonville, FL 32223
Phone (904) 383-7613

630 Kingsley Ave
Orange Park, FL 32073
Phone (386) 872-2629

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769904000000",
    "number": "1275870388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735465",
            "telephone_number": "904-337-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 SE APACHE WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320251723",
            "telephone_number": "407-493-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "AMY",
        "name_prefix": "Miss",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-09",
        "last_updated": "2026-02-01",
        "certification_date": "2026-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0013812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "SCHAET",
            "credential": "LMHC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2026; 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.