Active NPI
Mark Ryan Kelly, LPC, LCDC
- Professional Counselor
- Victoria, TX
National Provider Identifier
1366804742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 82018
- Practice address
- 802 E Crestwood Dr
Victoria, TX 77901-3309 - Phone
- (361) 576-4673
- NPI assigned
- Mar 24, 2016
- Last updated
- Jan 21, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 82018 | TX | Primary |
Addresses
Primary practice location
802 E Crestwood Dr
Victoria, TX 77901-3309
Mailing address
802 E Crestwood Dr
Victoria, TX 77901-3309
Phone (361) 576-4673
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82018 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768953600000",
"number": "1366804742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 E CRESTWOOD DR",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779013309",
"telephone_number": "361-576-4673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 E CRESTWOOD DR",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779013309",
"telephone_number": "361-576-4673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MARK",
"middle_name": "RYAN",
"credential": "LPC, LCDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-24",
"last_updated": "2026-01-21",
"certification_date": "2026-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "82018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victoria, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.