Kristen Gidel Kelly, LPCC, LICDC, CTTS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.1110035 Issued in OH

Practice address

384 Streamwater Dr
Blacklick, OH 43004-8132

Phone

(419) 344-9079

NPI assigned

Jul 31, 2016

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 identifiers 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.

• Imagine Recovery Counseling

  • Mental Health Counselor
  • Gahanna, OH
  • NPI 1548839731
  NPD Authorized official

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

{
    "created_epoch": "1469923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469923200000",
    "number": "1467905075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 STREAMWATER DR",
            "city": "BLACKLICK",
            "state": "OH",
            "postal_code": "430048132",
            "telephone_number": "419-344-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 STREAMWATER DR",
            "city": "BLACKLICK",
            "state": "OH",
            "postal_code": "430048132",
            "telephone_number": "419-344-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KRISTEN",
        "middle_name": "GIDEL",
        "credential": "LPCC, LICDC, CTTS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-31",
        "last_updated": "2016-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1110035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF VETERANS AFFAIRS",
            "identifier": "757",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Blacklick, OH
• Providers in Blacklick, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2016; 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.