Kelley Lynn Johnson, LCPC-S, LCAC
Individual provider Active NPI Professional Counselor · Great Bend, KS
NPI 1639296759 · NPPES record last updated Apr 2, 2025
Key facts
- NPI
- 1639296759
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2362 (KS)
- Practice address
- 809 S Patton
PO Box 1223
Great Bend, KS 67530 - Phone
- (620) 796-2206
- Fax
- (620) 796-2208
- NPI assigned
- Mar 23, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avenues for Change
Practice addresses (Care Compare)
809 S Patton Rd
Great Bend, KS 67530-4620
Phone (620) 796-2206
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240905004666 | KS | Practitioner - Mental Health Counselor | 5395285282 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2362 | KS | MD | Marriage & Family Therapist |
| 660 | KS | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avenues for Change | Current |
Accepting new patients | |
| Healing Hearts Ranch | Past |
Accepting new patients | |
| HHR Therapeutic Services, LLC | Past | Accepting new patients |
Locations
809 S Patton Rd
Great Bend, KS 67530
Phone (620) 796-2206
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 660 | KS | |
| Professional Counselor | 101YP2500X | 2362 | KS | Yes |
Addresses
Primary practice location
809 S Patton
PO Box 1223
Great Bend, KS 67530
Mailing address
PO Box 1223
Great Bend, KS 67530-1223
Phone (620) 796-2206
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100098090A | Medicaid | KS |
Other names
- Kelley Ferguson
Other providers in Great Bend, KS
- Dana A Jackson
- Jennings Chiropractic & Kinesiology PA
- Michael B Jennings
- Sally J. Jensen
- Jennifer J Johnson
- Ruth E Johnson
- Dalton Jones
- JVS DMD LLC
- Leonard A Kaiser
- Kansas Medical Specialists PA
All providers in Great Bend, KS · Professional Counselor in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.