Active NPI
Kelsey Blackaby
- Addiction (Substance Use Disorder) Counselor
- South Point, OH
National Provider Identifier
1295407641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.177739
- Practice address
- 335 Township Road 1026
South Point, OH 45680-7842 - Phone
- (740) 744-4055
- NPI assigned
- Oct 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.177739 | OH | Primary |
Addresses
Primary practice location
335 Township Road 1026
South Point, OH 45680-7842
Mailing address
PO Box 390
Huntington, WV 25708-0390
Phone (304) 429-1088
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
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.177739 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715126400000",
"number": "1295407641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 390",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257080390",
"telephone_number": "304-429-1088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 TOWNSHIP ROAD 1026",
"city": "SOUTH POINT",
"state": "OH",
"postal_code": "456807842",
"telephone_number": "740-744-4055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKABY",
"first_name": "KELSEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-04",
"last_updated": "2024-05-08",
"certification_date": "2024-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.177739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Point, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.