NPIMap

Organization Active NPI

Kelly Cole Licensed Clinical Social Worker Inc

  • Mental Health Counselor
  • Arcata, CA
National Provider Identifier
1487393971
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
KELLY COLE LICENSED CLINICAL SOCIAL WORKER INC
Practice address
655 F St Ste a
Arcata, CA 95521-6366
Phone
(707) 599-2856
NPI assigned
Jun 2, 2022
Last updated
Apr 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Kelly ColeNPI 1558496935
Title
Owner
Phone
(707) 599-2856

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

655 F St Ste a
Arcata, CA 95521-6366

Mailing address

PO Box 1123
Trinidad, CA 95570-1123

Other practice location 1

830 G St Ste 210
Arcata, CA 95521-6256
Phone (707) 599-2856

Other practice location 2

665 F St Ste C
Arcata, CA 95521-6364
Phone (707) 599-2856

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL kellycolelcsw@gmail.com

National Provider Directory

National Provider Directory

Locations

830 G St
Ste 210
Arcata, CA 95521
Phone (707) 706-0567

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1487393971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1123",
            "city": "TRINIDAD",
            "state": "CA",
            "postal_code": "955701123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 F ST STE A",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216366",
            "telephone_number": "707-599-2856"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "830 G St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Arcata",
            "state": "CA",
            "postal_code": "955216256",
            "country_code": "US",
            "telephone_number": "707-599-2856",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "665 F St Ste C",
            "address_purpose": "LOCATION",
            "city": "Arcata",
            "state": "CA",
            "postal_code": "955216364",
            "country_code": "US",
            "telephone_number": "707-599-2856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KELLY COLE LICENSED CLINICAL SOCIAL WORKER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-02",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-599-2856"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kellycolelcsw@gmail.com",
            "affiliation": "N",
            "address_1": "830 G St Ste 210",
            "city": "Arcata",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955216256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Arcata, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.