Jacob Lee Kellenberger, MS, TLLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6362009950 Issued in MI

Practice address

323 E Grand River Ave
Howell, MI 48843-2322

Phone

(909) 510-7626

NPI assigned

Aug 20, 2024

Sex

Male

Sole proprietor

No

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

Credentials

Master of Science

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 and National Provider Directory roles.

• Clinton County Medical Center Psychological Services PLLC

  • Family Medicine Physician
  • Saint Johns, MI
  • NPI 1538973144

  Clinical

  NPD (past)

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

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1902639693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 E GRAND RIVER AVE",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488432322",
            "telephone_number": "989-510-7626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E GRAND RIVER AVE",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488432322",
            "telephone_number": "909-510-7626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLENBERGER",
        "first_name": "JACOB",
        "middle_name": "LEE",
        "credential": "MS, TLLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6362009950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bernard Kazyak, M.S.W.
• KB Therapy and Consulting Services PLLC
• Ellen Marie Keefe-Garner, PMHNP-BC
• Samantha Keefer, DPT
• Lance Kehr II
• Amy Elizabeth Kelley
• Lee Kellogg, M.A. LBSW
• Thomas M Kellogg, DDS
• Kelly Kent Spallone PLLC
• Charles E Kelly, D.O.

• Clinical Psychologist in Howell, MI
• Providers in Howell, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.