Active NPI
Keely Chantale Black
- Professional Counselor
- Dallas, TX
National Provider Identifier
1376872697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 62324
- Practice address
- 3227 McKinney Ave
6E
Dallas, TX 75204-7424 - Phone
- (972) 977-2490
- NPI assigned
- Dec 16, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 62324 | TX | Primary |
Addresses
Primary practice location
3227 McKinney Ave
6E
Dallas, TX 75204-7424
Mailing address
3227 McKinney Ave
6E
Dallas, TX 75204-7424
Phone (972) 977-2490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1412 W Magnolia Ave
Suite 210
Fort Worth, TX 76104-4364
Phone (855) 284-7483
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Professional | Current | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260921600000",
"number": "1376872697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3227 MCKINNEY AVE",
"address_2": "6E",
"city": "DALLAS",
"state": "TX",
"postal_code": "752047424",
"telephone_number": "972-977-2490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3227 MCKINNEY AVE",
"address_2": "6E",
"city": "DALLAS",
"state": "TX",
"postal_code": "752047424",
"telephone_number": "972-977-2490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "KEELY",
"middle_name": "CHANTALE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-16",
"last_updated": "2009-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "62324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.