Active NPI
Brian Kelly, LMSW, LCDC
- Social Worker
- Austin, TX
National Provider Identifier
1801330436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 58143
- Practice address
- 240 Kensington LN
Austin, TX 78737-4505 - Phone
- (713) 899-6762
- NPI assigned
- Dec 16, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 58143 | TX | Primary |
Addresses
Primary practice location
240 Kensington LN
Austin, TX 78737-4505
Mailing address
240 Kensington LN
Austin, TX 78737-4505
Phone (713) 899-6762
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 |
|---|---|---|---|
| 58143 | TX | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481846400000",
"number": "1801330436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 KENSINGTON LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787374505",
"telephone_number": "713-899-6762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 KENSINGTON LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787374505",
"telephone_number": "713-899-6762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "BRIAN",
"credential": "LMSW, LCDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-16",
"last_updated": "2016-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "58143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.