Active NPI
Mark Andrew Kelley, LPC
- Marriage & Family Therapist
- High Point, NC
National Provider Identifier
1902949878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 4194
- Practice address
- 405 Westwood Ave
High Point, NC 27262-4325 - Phone
- (336) 887-7350
- Fax
- (336) 887-7353
- NPI assigned
- Feb 14, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 4194 | NC | Primary |
Addresses
Primary practice location
405 Westwood Ave
High Point, NC 27262-4325
Mailing address
405 Westwood Ave
High Point, NC 27262-4825
Phone (336) 887-7350
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13323 | Other | NC | BCBS PRIVATE INSURANCE |
| C5330 | Other | NC | MEDCOST PRIVATE INSURANCE |
| 6102011 | Medicaid | NC |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4194 | NC | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jake E. Ricketson High Point Psychological Assoc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- High Point, NC
- NPI 1083801781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902949878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 WESTWOOD AVE",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624825",
"telephone_number": "336-887-7350",
"fax_number": "336-887-7353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 WESTWOOD AVE",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624325",
"telephone_number": "336-887-7350",
"fax_number": "336-887-7353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "MARK",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "4194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PRIVATE INSURANCE",
"identifier": "13323",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST PRIVATE INSURANCE",
"identifier": "C5330",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102011",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in High Point, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.