Camille Grace Kelly

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

67761 Issued in CA

Practice address

1823 48TH St
San Diego, CA 92102

Phone

(619) 567-9353

NPI assigned

Apr 10, 2013

Sex

Female

Sole proprietor

Yes

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 CA

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

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.

• San Diego Therapy Center Inc.

  • Clinical Psychologist
  • Alpine, CA
  • NPI 1306117981
  Medicare reassignment NPD
• Solpath Family Counseling & Wellness Corp

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1659194900
  NPD
• Fusion Care Group, a Psychological Professional Corporation

  • Clinical Psychologist
  • Alpine, CA
  • NPI 1275177982
  NPD (past)

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1316380280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1823 48TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921021326",
            "telephone_number": "619-567-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 48TH ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92102",
            "telephone_number": "619-567-9353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 N Brookhurst St",
            "address_2": "Suite 320",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928015226",
            "country_code": "US",
            "telephone_number": "714-490-7711 x101",
            "fax_number": "714-490-7717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1823 48th St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92102",
            "country_code": "US",
            "telephone_number": "619-567-9353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CAMILLE",
        "middle_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-10",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "67761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne M. Kelly, MD
• Amanda Marie Kelly
• Barbara H. Kelly, PHD
• Brian Edward Kelly, MSW
• Brianna McNeal Kelly
• Carolyn Jean Kelly, M.D.
• Christian Nguyen Kelly
• Colleen Kelly
• Connor Kelly
• Donel Starr Kelly, MD

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, 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 Jun 18, 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.