Individual provider Active NPI

Kelly Aiello, LPC

  • Professional Counselor
  • Fort Gratiot, MI
National Provider Identifier
1689016248
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401013735 Issued in MI
Practice address
1501 Krafft Rd
Fort Gratiot, MI 48059-3565
Phone
(810) 985-5125
Fax
(810) 985-5127
NPI assigned
Jul 24, 2013
Last updated
Oct 10, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401013735 MI Primary

Addresses

Primary practice location

1501 Krafft Rd
Fort Gratiot, MI 48059-3565

Mailing address

1501 Krafft Rd
Fort Gratiot, MI 48059-3565
Phone (810) 985-5125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20241125001955 MI Practitioner - Mental Health Counselor 8820523095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Blue Water Mental Health ClinicGroup PAC ID 2769477264, 23 clinicians

Practice addresses (Care Compare)

1501 Krafft Rd
Fort Gratiot, MI 48059-3565
Phone (810) 985-5125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401013735MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Water Mental Health Clinic Professional CurrentSince Nov 7, 2024 Accepting new patients

Locations

1501 Krafft Rd
Fort Gratiot, MI 48059
Phone (810) 985-5125

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476057600000",
    "number": "1689016248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KRAFFT RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593565",
            "telephone_number": "810-985-5125",
            "fax_number": "810-985-5127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KRAFFT RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593565",
            "telephone_number": "810-985-5125",
            "fax_number": "810-985-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AIELLO",
        "first_name": "KELLY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-24",
        "last_updated": "2016-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gratiot, MI

Sources for this page

Verify at the official NPI Registry.