NPIMap

Organization Active NPI

Kelly Reeves Memorial Foundation

Doing business as Kelly's Grief Center

  • Professional Counselor
  • Kent, OH
National Provider Identifier
1295220986
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
KELLY REEVES MEMORIAL FOUNDATION
Doing business as
Kelly's Grief Center
Practice address
135 E Erie St Ste 302
Kent, OH 44240-3594
Phone
(330) 593-5959
NPI assigned
Jun 26, 2018
Last updated
Feb 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

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

Authorized official

Name
Phyllis A Vair, LPCNPI 1073031373
Title
Counselor
Phone
(330) 593-5959

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU Primary

Addresses

Primary practice location

135 E Erie St Ste 302
Kent, OH 44240-3594

Mailing address

135 E Erie St Ste 302
Kent, OH 44240-3594
Phone (330) 593-5959

Other names 1

  • Kelly's Grief Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220817001683 OH Part B Supplier - Clinic/Group Practice 2961885314 Receives reassigned benefits from 8 practitioners
Practice locations: Kent, OH

National Provider Directory

National Provider Directory

Locations

135 E Erie St
Ste 302
Kent, OH 44240
Phone (330) 593-5959

2275 State Route 59
Kent, OH 44240
Phone (330) 593-5959

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1295220986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 E ERIE ST STE 302",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442403594",
            "telephone_number": "330-593-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 E ERIE ST STE 302",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442403594",
            "telephone_number": "330-593-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY REEVES MEMORIAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-26",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "VAIR",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "330-593-5959",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly's Grief Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kent, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.