Active NPI
Jennifer Kelley
- Professional Counselor
- Fort Collins, CO
National Provider Identifier
1649789264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 1507 Riverside Ave Ste 202
Fort Collins, CO 80524-4382 - Phone
- (970) 658-6774
- NPI assigned
- Sep 26, 2017
- Last updated
- Apr 20, 2020
- 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 | NU | Primary |
Addresses
Primary practice location
1507 Riverside Ave Ste 202
Fort Collins, CO 80524-4382
Mailing address
6191 Bay Meadows Dr
Windsor, CO 80550-8075
Phone (970) 658-6774
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beyond the Mirror, LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Fort Collins, CO
- NPI 1265661169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587340800000",
"number": "1649789264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6191 BAY MEADOWS DR",
"city": "WINDSOR",
"state": "CO",
"postal_code": "805508075",
"telephone_number": "970-658-6774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1507 RIVERSIDE AVE STE 202",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805244382",
"telephone_number": "970-658-6774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-26",
"last_updated": "2020-04-20",
"certification_date": "2020-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.