Kelsey Krueger Cannan, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

010756 Issued in NY

Practice address

21 Gentian Way
Fairport, NY 14450-9210

Phone

(585) 690-7501

NPI assigned

Jun 20, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kelsey M Krueger Professional name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1942794151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GENTIAN WAY",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509210",
            "telephone_number": "585-690-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GENTIAN WAY",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509210",
            "telephone_number": "585-690-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNAN",
        "first_name": "KELSEY",
        "middle_name": "KRUEGER",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-20",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39004517A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "010756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "KRUEGER",
            "middle_name": "M",
            "credential": "LMHC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alicia Campbell
• Kristin D Campbell, SP. ED. TEACHER
• Raechel Campisi, OTR/L
• Heidi Jean Campoli, SLP
• Maureen Campolieto, TSHH, MSED
• Alyssa Canton
• Michele B Capellupo, SPECIAL EDUCATOR, 17
• Frank J Carberry Jr., DDS
• David A Carbonaro, D.D.S.
• Suzanne Mary Cardner, NYS LMT

• Mental Health Counselor in Fairport, NY
• Providers in Fairport, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.