Kelcy M Micklos

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

166.001572 Issued in IL

Practice address

6653 Weaver Rd Ste 12
Rockford, IL 61114-8025

Phone

(815) 201-2687

NPI assigned

Aug 5, 2020

Last updated

Aug 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

• Riverside Counseling Center PLLC

  dba Lindsey McClanathan

  • Counselor
  • Rockford, IL
  • NPI 1952879546
  NPD

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1649880519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6653 WEAVER RD STE 12",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6653 WEAVER RD STE 12",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148025",
            "telephone_number": "815-201-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKLOS",
        "first_name": "KELCY",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-05",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "208.000815",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166.001572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Degould DDS PC
• Michael S. Feldt, O.D., LTD.
• Brian Thomas Michalsen, D.O.
• Michael C Michelotti, MD
• Joseph Micho, MD
• Midtown Family Chiropractic
• Midwest Integrated Surgeons, PLLC
• Midwest Medical Institute S.C.
• Midwest Reproductive Health
• Midwest Surgical Care Center, LTD

• Marriage & Family Therapist in Rockford, IL
• Providers in Rockford, IL by specialty
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.