Active NPI
Kellie Cleaver
- Professional Counselor
- Dallas, OR
National Provider Identifier
1720646706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C7151
- Practice address
- 182 SW Academy St
Dallas, OR 97338-1996 - Phone
- (503) 623-9289
- NPI assigned
- Jun 4, 2019
- Last updated
- Nov 27, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | C7151 | OR | Primary |
Addresses
Primary practice location
182 SW Academy St
Dallas, OR 97338-1996
Mailing address
643 NW 10TH St
Corvallis, OR 97330-6111
Phone (971) 409-2043
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7151 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Psychological and Counseling Services LLC | Mental Health | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.kelliecleaver@151848.advancedmd-direct.com
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.
-
dba LifeStance Health
- Clinical Psychologist
- Tacoma, WA
- NPI 1912008178
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732665600000",
"number": "1720646706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "643 NW 10TH ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973306111",
"telephone_number": "971-409-2043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "182 SW ACADEMY ST",
"city": "DALLAS",
"state": "OR",
"postal_code": "973381996",
"telephone_number": "503-623-9289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEAVER",
"first_name": "KELLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-04",
"last_updated": "2024-11-27",
"certification_date": "2024-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C7151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.