David Scott Kelly, MA,CAADC,MAC,CCS

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6802062018 Issued in MI

Practice address

101 M 66 N
Charlevoix, MI 49720-9338

Phone

(231) 547-1144

Fax

(231) 547-4970

NPI assigned

Jul 20, 2015

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

Credentials

Master of Arts

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.

• Bay Area Substance Education Services

  • Mental Health Counselor
  • Charlevoix, MI
  • NPI 1790053270

  Addiction (Substance Use Disorder)

  NPD

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1679958664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 M 66 N",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209338",
            "telephone_number": "231-547-1144",
            "fax_number": "231-547-4970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 M 66 N",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209338",
            "telephone_number": "231-547-1144",
            "fax_number": "231-547-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DAVID",
        "middle_name": "SCOTT",
        "credential": "MA,CAADC,MAC,CCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-20",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "SA0150013",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802062018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20151209439760",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dennis M Joy, M.D.
• Elizabeth Ann Kaelson, DDS
• Dennis J Kan, LLBSW
• Justin Robert Kapke, PA
• Lori A Katzman, M.D.
• Vicki Kemp
• Barrett Alexander Kielhorn, D.O.
• Susan Mary Killam, RN,MSN,NP
• Laura Kitzmiller, M.D.
• Brian Raymond Kwapisz, D.D.S.

• All providers in Charlevoix, MI
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.