Active NPI
Georgie A Kelly, MA, LPCC
- Mental Health Counselor
- San Diego, CA
National Provider Identifier
1376029983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 9136
- Practice address
- 11858 Bernardo Plaza CT Ste 210
San Diego, CA 92128-2411 - Phone
- (858) 304-0928
- Fax
- (858) 592-1495
- NPI assigned
- Jul 17, 2018
- Last updated
- Jan 25, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 9136 | CA | Primary |
Addresses
Primary practice location
11858 Bernardo Plaza CT Ste 210
San Diego, CA 92128-2411
Mailing address
11858 Bernardo Plaza CT Ste 210
San Diego, CA 92128-2411
Phone (858) 304-0928
Other names 1
- Rachel Angela Kelly
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 20, 2025 through Sep 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9136 | CA | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643068800000",
"number": "1376029983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11858 BERNARDO PLAZA CT STE 210",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921282411",
"telephone_number": "858-304-0928",
"fax_number": "858-592-1495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11858 BERNARDO PLAZA CT STE 210",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921282411",
"telephone_number": "858-304-0928",
"fax_number": "858-592-1495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "GEORGIE",
"middle_name": "A",
"credential": "MA, LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-17",
"last_updated": "2022-01-25",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "9136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RACHEL",
"last_name": "KELLY",
"middle_name": "ANGELA",
"credential": "MA, APCC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.