Active NPI
Kimberly Michelle Kelley, LPC
- Professional Counselor
- Bend, OR
National Provider Identifier
1619104338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1101
- Practice address
- 15 SW Colorado Ave
Ste. 130
Bend, OR 97702-1150 - Phone
- (541) 480-3665
- Fax
- (541) 550-3887
- NPI assigned
- Jun 20, 2009
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1101 | OR | Primary |
Addresses
Primary practice location
15 SW Colorado Ave
Ste. 130
Bend, OR 97702-1150
Mailing address
PO Box 1225
Bend, OR 97709-1225
Phone (541) 480-3665
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 |
|---|---|---|---|
| C1101 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468886400000",
"number": "1619104338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1225",
"city": "BEND",
"state": "OR",
"postal_code": "977091225",
"telephone_number": "541-480-3665",
"fax_number": "541-550-3887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 SW COLORADO AVE",
"address_2": "STE. 130",
"city": "BEND",
"state": "OR",
"postal_code": "977021150",
"telephone_number": "541-480-3665",
"fax_number": "541-550-3887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "KIMBERLY",
"middle_name": "MICHELLE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-20",
"last_updated": "2016-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.