Active NPI
Kelly Michael McCall
- Mental Health Counselor
- Lake Forest, CA
National Provider Identifier
1508353038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 92112
- Practice address
- 24302 Toledo LN
Lake Forest, CA 92630-1935 - Phone
- (949) 716-0956
- NPI assigned
- Apr 19, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | CA | ||
| Mental Health Counselor | 101YM0800X | 92112 | CA | Primary |
Addresses
Primary practice location
24302 Toledo LN
Lake Forest, CA 92630-1935
Mailing address
24302 Toledo LN
Lake Forest, CA 92630-1935
Phone (949) 742-2121
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 |
|---|---|---|---|
| 92112 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566000000000",
"number": "1508353038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24302 TOLEDO LN",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926301935",
"telephone_number": "949-742-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24302 TOLEDO LN",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926301935",
"telephone_number": "949-716-0956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCALL",
"first_name": "KELLY",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-19",
"last_updated": "2019-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "92112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Forest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.