Shijuan Kelly, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801093330 Issued in MI

Practice address

520 Superior Street
Port Huron, MI 48060-3541

Phone

(810) 984-4202

NPI assigned

Jul 31, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Professional Counseling Center,P.C.Group PAC ID 1759370208, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Professional Counseling Center,P.C.

  • Addiction (Substance Use Disorder) Counselor
  • Port Huron, MI
  • NPI 1225049760

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• A Place for Just US Counseling

  • Social Worker
  • Muskegon, MI
  • NPI 1649739178
  NPD Authorized official

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1558793612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR STREET",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603541",
            "telephone_number": "810-984-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR STREET",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603541",
            "telephone_number": "810-984-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHIJUAN",
        "name_prefix": "Miss",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-31",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801093330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558793612",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Keaney
• Pamela J Kearns
• Karen Sue Kegler, FNP
• Barbara Kehoe, RN
• Alyssa Jean Keller, DDS
• Sharon Kemp-McLaren, PT
• Chelsea Renee Kendrick-Singh
• Thomas Michael Kennedy, LPC
• Laura Ann Kenny, LMSW
• Kelly Elizabeth Kerhoulas, C.R.N.A.

• Clinical Social Worker in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.