Kelly Manuel, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

67396 Issued in TX

Practice address

111 N Hasler Blvd Ste 219
Bastrop, TX 78602-3984

Phone

(512) 743-9573

NPI assigned

Nov 15, 2021

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

Other names 1

• Kelly A Manuel Former name

Electronic endpoints 1

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.

• Kelly Manuel Bastrop Counseling, PLLC

  • Clinical Social Worker
  • Bastrop, TX
  • NPI 1033870662
  NPD Authorized official

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

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1396401212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 LISA LN UNIT B",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786025782",
            "telephone_number": "512-743-9583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N HASLER BLVD STE 219",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786023984",
            "telephone_number": "512-743-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANUEL",
        "first_name": "KELLY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-15",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "67396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://headway.com",
            "affiliation": "N",
            "address_1": "114 5th Ave Fl 2",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100115611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MANUEL",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Raquel Marquez
• Ryan J Marsh
• Jeremy Dean Martinelli, AGCNS-BC

• Clinical Social Worker in Bastrop, TX
• Providers in Bastrop, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.