Kelly Dae Kettlewell, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

PS017216 Issued in PA

Practice address

49 E 4TH St Ste 205
Williamsport, PA 17701-6355

Phone

(570) 601-4788

NPI assigned

Feb 15, 2022

Last updated

Feb 8, 2023By the provider in NPPES

Sex

Female

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

Credentials

Doctor of Philosophy

State licenses

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.

• Central Keystone Counseling, LLC

  • Psychologist
  • Williamsport, PA
  • NPI 1437891595
  NPD
• Central Keystone Counseling: Couples & Family, LLC

  • Psychologist
  • Williamsport, PA
  • NPI 1407703366
  NPD (past)

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

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1285389544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 E 4TH ST STE 205",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016355",
            "telephone_number": "570-601-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 E 4TH ST STE 205",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016355",
            "telephone_number": "570-601-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLEWELL",
        "first_name": "KELLY",
        "middle_name": "DAE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-15",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PA",
            "license": "PS017216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Leah Keppler, LPC
• Marillyn Kern
• Jeanne M Kerschner, OTRL
• Rachael D. Kershner
• Christine Kessler, PA-C
• Keystone Chiropractic, LTD, PC.
• Keystone Omfs PC (Susquehanna Oral & Facial Surgery & Implant Center)
• Ayaz M Khan, M.D.
• Ayesha Asghar Khan, D)
• Rafay Khan, DO

• Counseling Psychologist in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Counseling Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.