Patrick C Kelley, LCDCIII, QMHS

Primary specialty

CounselorTaxonomy code 101Y00000X

License

C.2305166-TRNE Issued in OH

Practice address

225 Carlton Davidson LN
Coal Grove, OH 45638-2924

Phone

(740) 533-0648

Fax

(740) 353-1662

NPI assigned

Apr 23, 2018

Last updated

Sep 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• United Family Recovery, LLC

  • Community/Behavioral Health Agency
  • Coal Grove, OH
  • NPI 1598366346
  NPD (past)
• United Family Recovery, LLC

  • Community/Behavioral Health Agency
  • Coal Grove, OH
  • NPI 1972100014

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1659868941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 WASHINGTON ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623944",
            "telephone_number": "740-354-7702",
            "fax_number": "740-353-1662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CARLTON DAVIDSON LN",
            "city": "COAL GROVE",
            "state": "OH",
            "postal_code": "456382924",
            "telephone_number": "740-533-0648",
            "fax_number": "740-353-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "PATRICK",
        "middle_name": "C",
        "credential": "LCDCIII, QMHS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-23",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.162407",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.2305166-TRNE",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361745",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ironton & Lawrence County Area Community Action Organization (Kemp Family Medical Center)
• Lisa Jackson, LSW
• Kelly Jenkins, PEER SUPPORTER
• Ian Jennings, CDCA.193079
• Kayla Jean Kelley, PMHNP
• Charles Kerns, CDCAPRE.195369
• Stacey Klaiber, LPN
• Elizabeth Lambiotte, MA, CCC-SLP
• Lawrence County Board of Mental Retardation Development Disabilities
• Lawrence County Developmental Disabilities

• Counselor in Coal Grove, OH
• Providers in Coal Grove, OH by specialty
• Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.