Kellie R Wylie, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

58307 Issued in TX

Practice address

3700 N Hills Dr
Austin, TX 78731-3022

Phone

(512) 960-4533

Fax

(512) 887-3970

NPI assigned

Mar 12, 2019

Sex

Female

Sole proprietor

No

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Austin Travis County Mental Health and Mental Retardation Center

  • Psychiatry Physician
  • Austin, TX
  • NPI 1750337259

  Clinical

  Medicare reassignment NPD
• Bluebonnet Trails Community MHMR Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Round Rock, TX
  • NPI 1730135864

  Clinical

  Medicare reassignment NPD
• Austin Travis County Mental Health and Mental Retardation Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Austin, TX
  • NPI 1053632505
  NPD
• Bluebonnet Trails Community MHMR Center

  • Rural Health Clinic/Center
  • La Grange, TX
  • NPI 1518536309
  NPD

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552348800000",
    "number": "1295293942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 W BEN WHITE BLVD STE 210A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787047182",
            "telephone_number": "512-960-4533",
            "fax_number": "512-887-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 N HILLS DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787313022",
            "telephone_number": "512-960-4533",
            "fax_number": "512-887-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLIE",
        "first_name": "KELLIE",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "58307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank David Wyatt Jr., MS,RD, CSO, LD
• Logan Alyse Wyatt
• Sarah Wyatt, LCSW
• Sarah K Wycheck
• Sandra R Wyers, MS, RDN
• Rigel Tenya Wymore, LCSW
• Mary L Wynn-Johnson, CRNA
• Elisha Wynn, LCSW
• Michael Preston Wynn, MD MPH
• Joellen Wynne, FNP

• Clinical Social Worker in Austin, TX
• Providers in Austin, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.