Active NPI
Carla Jean Kelly, LPC, LLPC
- Professional Counselor
- Portage, MI
National Provider Identifier
1477214575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401004965
- Practice address
- 800 E Milham Ave
Portage, MI 49002-1490 - Phone
- (269) 249-7179
- NPI assigned
- Jan 2, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401004965 | MI | Primary |
Addresses
Primary practice location
800 E Milham Ave
Portage, MI 49002-1490
Mailing address
6752 Pleasantview Dr
Portage, MI 49024-1004
Phone (269) 352-1857
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6401004965 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641081600000",
"number": "1477214575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6752 PLEASANTVIEW DR",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490241004",
"telephone_number": "269-352-1857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E MILHAM AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490021490",
"telephone_number": "269-249-7179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "CARLA",
"middle_name": "JEAN",
"credential": "LPC, LLPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-02",
"last_updated": "2022-01-02",
"certification_date": "2022-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401004965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.