Active NPI
Kelly C Pemberton, MED, LPC
- Professional Counselor
- Richardson, TX
National Provider Identifier
1811206691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 62609
- Practice address
- 2005 Columbia Dr
Richardson, TX 75081-3206 - Phone
- (214) 683-4805
- NPI assigned
- Sep 28, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 62609 | TX | |
| Mental Health Counselor | 101YM0800X | 62609 | TX | |
| Professional Counselor | 101YP2500X | 62609 | TX | Primary |
Addresses
Primary practice location
2005 Columbia Dr
Richardson, TX 75081-3206
Mailing address
2005 Columbia Dr
Richardson, TX 75081-3206
Phone (214) 683-4805
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62609 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342656000000",
"number": "1811206691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 COLUMBIA DR",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750813206",
"telephone_number": "214-683-4805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 COLUMBIA DR",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750813206",
"telephone_number": "214-683-4805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEMBERTON",
"first_name": "KELLY",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "MED, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-28",
"last_updated": "2012-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "62609",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "62609",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "62609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richardson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.