Active NPI
Kelly Herzberg
- Mental Health Counselor
- Tacoma, WA
National Provider Identifier
1679167068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LH60585400
- Practice address
- 1148 Broadway Ste 100
Tacoma, WA 98402-3518 - Phone
- (253) 597-4550
- NPI assigned
- Feb 25, 2021
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH60585400 | WA | Primary |
Addresses
Primary practice location
1148 Broadway Ste 100
Tacoma, WA 98402-3518
Mailing address
1148 Broadway Ste 100
Tacoma, WA 98402-3518
Phone (253) 597-4550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 8, 2024 through Oct 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH60585400 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614211200000",
"number": "1679167068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1148 BROADWAY STE 100",
"city": "TACOMA",
"state": "WA",
"postal_code": "984023518",
"telephone_number": "253-597-4550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1148 BROADWAY STE 100",
"city": "TACOMA",
"state": "WA",
"postal_code": "984023518",
"telephone_number": "253-597-4550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERZBERG",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-25",
"last_updated": "2021-02-25",
"certification_date": "2021-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH60585400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.