Michael Kelly
Individual provider Active NPI Mental Health Counselor · Watertown, NY
NPI 1861209405 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1861209405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 211 JB Wise PL
Watertown, NY 13601-2507 - Phone
- (315) 782-7445
- NPI assigned
- Dec 17, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Home of Jefferson County | Current |
Accepting new patients | |
| Children'S Home of Jefferson County | Current |
Accepting new patients |
Locations
1704 State St
Watertown, NY 13601
Phone (315) 788-7430
211 Jb Wise Pl
Watertown, NY 13601
Phone (315) 788-7430
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
211 JB Wise PL
Watertown, NY 13601-2507
Mailing address
1704 State St
Watertown, NY 13601-3102
Phone (315) 782-7445
Other providers in Watertown, NY
- Tracey Lee Kellar
- Amanda Keller
- Christopher Allan Kellogg
- Collins F Kellogg Jr.
- Connor Collins Kellogg
- Katelyn Kennedy
- Secret Angel Kennedy
- Abbey Frances Kerr
- Rebecca Keshmiri
- Cindy Kessler
All providers in Watertown, NY · Mental Health Counselor in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.