Individual provider Active NPI

Kelsey Leigh Gill

  • Addiction (Substance Use Disorder) Counselor
  • Shelby, OH
National Provider Identifier
1447875547
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA.182472 Issued in OH
Practice address
2775 State Route 39
Shelby, OH 44875-9466
Phone
(419) 747-3322
NPI assigned
Jun 15, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.182472 OH Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

2775 State Route 39
Shelby, OH 44875-9466

Mailing address

7155 Olivesburg Fitchville Rd
Greenwich, OH 44837-9603
Phone (419) 496-3345

Other practice location 1

741 Scholl Rd
Mansfield, OH 44907-1571
Phone (419) 756-1717

Other practice location 2

3100 E 45th St Ste 212
Cleveland, OH 44127-1093
Phone (216) 341-5510

Other identifiers 1

IdentifierTypeStateIssuer
0406830MedicaidOH

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CDCA.182472OHMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Family Solutions of Ohio Inc CurrentSince Jun 1, 2020 Accepting new patients
Cornell Abraxas Group, LLC PastSince Nov 6, 2022 Accepting new patients

Locations

3100 E 45th St
Ste 212
Cleveland, OH 44127
Phone (216) 341-5510

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": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1447875547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7155 OLIVESBURG FITCHVILLE RD",
            "city": "GREENWICH",
            "state": "OH",
            "postal_code": "448379603",
            "telephone_number": "419-496-3345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 STATE ROUTE 39",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448759466",
            "telephone_number": "419-747-3322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "741 Scholl Rd",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "OH",
            "postal_code": "449071571",
            "country_code": "US",
            "telephone_number": "419-756-1717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3100 E 45th St Ste 212",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441271093",
            "country_code": "US",
            "telephone_number": "216-341-5510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILL",
        "first_name": "KELSEY",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.182472",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0406830",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.