Kelly M Deroos, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

001602 Issued in IA

Practice address

300 W Broadway Ste 240
Council Bluffs, IA 51503-9028

Phone

(402) 882-0583

Fax

(712) 254-8829

NPI assigned

May 28, 2013

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

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Unmc Physicians

  • Multi-Specialty Clinic/Center
  • Omaha, NE
  • NPI 1417912114

  NE

  Medicare reassignment NPD
• Your Self-Care Therapy LLC

  • Mental Health Counselor
  • Council Bluffs, IA
  • NPI 1790314243

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1457798779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY STE 240",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515039028",
            "telephone_number": "402-882-0583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY STE 240",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515039028",
            "telephone_number": "402-882-0583",
            "fax_number": "712-254-8829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "142 E Palmer Ave",
            "address_purpose": "LOCATION",
            "city": "Council Bluffs",
            "state": "IA",
            "postal_code": "515035057",
            "country_code": "US",
            "telephone_number": "712-328-2806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEROOS",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-28",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Denich
• Laura P Denning, NP
• Jessie Lynn Derby, M.S. SLP
• Rhonda Deremer
• Margaret Dermody
• Anand Deshmukh, MD
• Kaitlin Nicole Desoe, APRN
• Developmental Disability Center of Iowa LLC
• Patsy Devereaux
• Gary Devoss, M.D.

• All providers in Council Bluffs, IA
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.