Kellie Calderon

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.012970 Issued in IL

Practice address

14007 S Bell Rd Ste 183
Homer Glen, IL 60491

Phone

(708) 553-0602

NPI assigned

Nov 21, 2016

Last updated

Jun 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kellie Olson 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ace Counseling Group LLC

  • Mental Health Counselor
  • Homer Glen, IL
  • NPI 1194341586
  NPD Authorized official
• Ace Counseling Group LLC

  dba Ace Counseling Group

  • Adult Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1346136199
  NPD Authorized official

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1417490681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14007 S BELL RD STE 183",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604918463",
            "telephone_number": "708-553-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14007 S BELL RD STE 183",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "60491",
            "telephone_number": "708-553-0602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "945 W George St Ste 206",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60657",
            "country_code": "US",
            "telephone_number": "708-945-0085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALDERON",
        "first_name": "KELLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-21",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.012283",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.012970",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178012283",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1 NUMBER",
            "identifier": "1417490681",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcalderon@acecounselors.com",
            "affiliation": "N",
            "endpointDescription": "Secure Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email Address",
            "address_1": "14007 S Bell Rd Ste 183",
            "city": "Homer Glen",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604918463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "OLSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Raeann Burke
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• Bruce G Burkhart, D.C.
• Stephanie Lynne Burkhart, PT, DPT
• C & a Testing LLC
• Richard Thomas Caleel, DO
• Jaime Callan
• Casey Campagna
• Hollie Fay Campbell
• Ahmet Can, PH.D., LPC, NCC

• Mental Health Counselor in Homer Glen, IL
• Providers in Homer Glen, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.