NPIMap

Individual provider Active NPI

Keegan Pollak, CPC-INTERN

  • Professional Counselor
  • Sparks, NV
National Provider Identifier
1295352920
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CI2892 Issued in NV
Practice address
375 Harbour Cove Dr Apt 407
Sparks, NV 89434-7807
Phone
(405) 269-1003
NPI assigned
Jun 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 CI2892 NV Primary

Addresses

Primary practice location

375 Harbour Cove Dr Apt 407
Sparks, NV 89434-7807

Mailing address

375 Harbour Cove Dr Apt 407
Sparks, NV 89434-7807
Phone (405) 269-1003

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address keegan.pollak@vitalityunlimited.org Direct Vitality Unlimited

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Mar 11, 2024 through Mar 11, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vitality Unlimited PastSince Jan 1, 2024 Accepting new patients
Vitality Unlimited Past Accepting new patients
Vitality Unlimited PastSince Feb 23, 2025 Accepting new patients
Edwards and Von Ravensberg, Prof. LLC Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1295352920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 HARBOUR COVE DR APT 407",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894347807",
            "telephone_number": "405-269-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 HARBOUR COVE DR APT 407",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894347807",
            "telephone_number": "405-269-1003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLAK",
        "first_name": "KEEGAN",
        "credential": "CPC-INTERN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NV",
            "license": "CI2892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keegan.pollak@vitalityunlimited.org",
            "affiliation": "Y",
            "endpointDescription": "Professional Email",
            "affiliationName": "Vitality Unlimited",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3740 Idaho St",
            "city": "Elko",
            "state": "NV",
            "country_code": "US",
            "postal_code": "898014611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sparks, NV

Sources for this page

Verify at the official NPI Registry.