Michaela Mary Kelly, LMHC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6542 Issued in SC

Practice address

815 Willow Wood LN Apt 104
Rock Hill, SC 29730-6692

Phone

(407) 963-0510

NPI assigned

Apr 17, 2020

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

Medicare fee-for-service enrollment

Enrolled in FL, SC2 enrollments

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 2

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  FL, Professional, SC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1578183745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 WILLOW WOOD LN APT 104",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297306692",
            "telephone_number": "407-963-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 WILLOW WOOD LN APT 104",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297306692",
            "telephone_number": "407-963-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAELA",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "LMHC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11664",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "6542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Franklin Mi'Kael Kelly, DC
• Jeremy A Kelly
• Khadijah Kelly, DDS
• Marie Michelle Kelly, MCD CCC-SLP
• Marsha D Kelly, C.N.M.
• Timothy J Kelly, M.D.
• Wendy Kemmer, FNP
• Jessica Maclaurin Kemp
• Rita J. Kennamer, CRNA
• Kyle Kennedy, DPT

• Professional Counselor in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.