Active NPI
Sharon Kelly, MA, LLP, CAAC
- Psychologist
- Three Rivers, MI
National Provider Identifier
1629064381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301004068
- Practice address
- 210 S Main St
Three Rivers, MI 49093-1624 - Phone
- (269) 273-5000
- Fax
- (269) 273-8019
- NPI assigned
- Sep 27, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301004068 | MI | Primary |
Addresses
Primary practice location
210 S Main St
Three Rivers, MI 49093-1624
Mailing address
677A East Main
Centreville, MI 49032
Phone (269) 467-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1708146 | Medicaid | MI | |
| P10G510150 | Other | MI | BCBS |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301004068 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Mental Health Services of St Joseph County | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Centreville, MI
- NPI 1366438483
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247788800000",
"number": "1629064381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "677A EAST MAIN",
"city": "CENTREVILLE",
"state": "MI",
"postal_code": "49032",
"telephone_number": "269-467-1000",
"fax_number": "269-467-3075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S MAIN ST",
"city": "THREE RIVERS",
"state": "MI",
"postal_code": "490931624",
"telephone_number": "269-273-5000",
"fax_number": "269-273-8019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "SHARON",
"name_prefix": "Ms.",
"credential": "MA, LLP, CAAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-27",
"last_updated": "2009-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301004068",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1708146",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "P10G510150",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Three Rivers, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.