Gary Kelly

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

AMFT106955 Issued in CA

Practice address

4401 Crenshaw Blvd
Los Angeles, CA 90043-1227

Phone

(323) 290-8360

NPI assigned

Jul 15, 2018

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Wellnest Emotional Health & Wellness

  • Community/Behavioral Health Agency
  • Los Angeles, CA
  • NPI 1639293574
  NPD

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

{
    "created_epoch": "1531612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1306322128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 S VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900073033",
            "telephone_number": "323-373-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 CRENSHAW BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900431227",
            "telephone_number": "323-290-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "GARY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-15",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT106955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• El'Lina Janay Kelly
• Emma Kelly
• Enda Kelly, MD
• Erin Kelly, PHD
• Erin Shigeko Kelly, M.D.
• Jaharra Kelly
• James Kelly, L.AC.
• James Aaron Kelly, DDS., MS
• Janessa Kelly
• John Patrick Kelly, M.D.

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.