Shelly Marie Kennedy-Gonzalez, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

06888 Issued in OK

Practice address

2017 S Elm PL Ste 104
Broken Arrow, OK 74012-7034

Phone

(918) 379-4431

Fax

(918) 328-2380

NPI assigned

Jun 14, 2016

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

Other names 1

• Shelly Bilby-Logan Former name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evolution Mental Health Services PLLCGroup PAC ID 5496106593, 6 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Evolution Mental Health Services PLLC

  • Mental Health Counselor
  • Tulsa, OK
  • NPI 1831714815
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762560000000",
    "number": "1679923320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6931 S 66TH EAST AVE STE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741331765",
            "telephone_number": "918-379-4431",
            "fax_number": "918-328-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 S ELM PL STE 104",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127034",
            "telephone_number": "918-379-4431",
            "fax_number": "918-328-2380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6931 S 66th East Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741331765",
            "country_code": "US",
            "telephone_number": "918-379-4431",
            "fax_number": "918-328-2380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY-GONZALEZ",
        "first_name": "SHELLY",
        "middle_name": "MARIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-14",
        "last_updated": "2025-11-08",
        "certification_date": "2025-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "06888",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OK",
            "license": "6888",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "BILBY-LOGAN",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristin Kelley, RN IBCLC
• Lee Ann Kelley
• Jacquelyn Michelle Kelly Hall
• Brooklyn Danielle Kelly, COTA/L
• Rustyn Kelly
• Karissa Brooke Kennedy
• Lauren Kennison
• Kenosha Breeze Family Dental PLLC
• Bailey Rae Keough
• Whitney Rochelle Kern, FNP

• Mental Health Counselor in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.