Mary Lee Kelley, LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15183 Issued in TX

Practice address

4645 Samuell Blvd
Dallas, TX 75228-6826

Phone

(214) 743-1200

NPI assigned

Nov 7, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1636243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1821753591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6619 WHITNEYGLEN DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752413785",
            "telephone_number": "214-414-6797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 SAMUELL BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752286826",
            "telephone_number": "214-743-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6619 Whitneyglen Dr",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752413785",
            "country_code": "US",
            "telephone_number": "214-414-6797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MARY",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-07",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "15183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Denise Kelley
• Karen Sue Kelley, MS, MED, LPC, LMFT
• Latrivia Dawn Kelley
• Layne Elizabeth Kelley, MD
• Margaret M Kelley, P.A.-C
• Matthew Kelley
• Megan Elizabeth Kelley
• Russell Phelps Kelley IV, M.D.
• Shannon Kelley, M.D.
• Sonia Kelley, OD, MS

• Addiction (Substance Use Disorder) Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; 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.