Connie L Kellogg, LCMHC
Individual provider Active NPI Mental Health Counselor · St Johnsbury, VT
NPI 1790922151 · NPPES record last updated Jan 7, 2009
Key facts
- NPI
- 1790922151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 068-0000761 (VT)
- Practice address
- 231 Concord Ave
Suite #3
St Johnsbury, VT 05819-1513 - Phone
- (802) 748-9555
- NPI assigned
- Jan 7, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
102 Bethany PL
Goldsboro, NC 27530-9683
Phone (802) 535-6385
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VT, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240103002857 | VT | Practitioner - Mental Health Counselor | 0446600423 | Practice locations: Barre, VT |
| I20251122000859 | NC | Practitioner - Mental Health Counselor | 0446600423 | Practice locations: Goldsboro, NC |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068-0000761 | VT | MD | Mental Health Counselor |
| 21436 | NC | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 068-0000761 | VT | Yes |
Addresses
Primary practice location
231 Concord Ave
Suite #3
St Johnsbury, VT 05819-1513
Mailing address
231 Concord Ave
Suite #3
St Johnsbury, VT 05819-1513
Phone (802) 748-9555
Other providers in St Johnsbury, VT
- Marin Beth Katz
- Annick-Marie Votteler Kaufman
- Jeannette D Keenan
- Keene Medical Products, LLC
- Christina Keene
- Alexa C Kemeny
- Molly Joan King -Gove
- Kingdom Autism and Behavioral Health, LLC
- Matthew Christopher Kirby
- Linda S. Kissane
All providers in St Johnsbury, VT · Mental Health Counselor in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.