Irving Kelley Jr.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LGPC00181 Issued in DC

Practice address

3500 Pope St SE
Washington, DC 20020-2356

Phone

(202) 439-9123

NPI assigned

Oct 12, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Prep

  • Home Health Agency
  • Washington, DC
  • NPI 1942053640
  NPD Authorized official

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1801361100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 POPE ST SE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200202356",
            "telephone_number": "202-439-9123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 POPE ST SE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200202356",
            "telephone_number": "202-439-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "IRVING",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-12",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "DC",
            "license": "LGPC00181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS",
            "identifier": "1903",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS",
            "identifier": "1973",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Kelley, D.D.S.
• Demetrius Kelley
• Demi W Kelley, RN
• Faith Renee Kelley, MD
• Francisco Alfredo Kelley, MD
• Lasara Kelley
• Latrell Kelley
• Lilly Kelley
• Mary Diane Kelley, PCA
• Melissa Ann Kelley, MD

• Mental Health Counselor in Washington, DC
• Providers in Washington, DC by specialty
• Mental Health Counselor in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; 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.