Active NPI
Erin Marie Kelly, LCPC
- Counselor
- Blue Island, IL
National Provider Identifier
1548728140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 180.011146
- Practice address
- 12630 Ann St
Blue Island, IL 60406-1704 - Phone
- (773) 710-8620
- NPI assigned
- Mar 4, 2019
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 180.011146 | IL | Primary |
Addresses
Primary practice location
12630 Ann St
Blue Island, IL 60406-1704
Mailing address
12630 Ann St
Blue Island, IL 60406-1704
Phone (773) 710-8620
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 |
|---|---|---|---|
| 180.011146 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551657600000",
"number": "1548728140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12630 ANN ST",
"city": "BLUE ISLAND",
"state": "IL",
"postal_code": "604061704",
"telephone_number": "773-710-8620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12630 ANN ST",
"city": "BLUE ISLAND",
"state": "IL",
"postal_code": "604061704",
"telephone_number": "773-710-8620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ERIN",
"middle_name": "MARIE",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-04",
"last_updated": "2019-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "180.011146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Island, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.