Active NPI
Kelly Lynn Nicodemus
- Mental Health Counselor
- Johnstown, PA
National Provider Identifier
1952605693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 131 Market St
Johnstown, PA 15901-1628 - Phone
- (814) 623-1212
- NPI assigned
- Jan 10, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
131 Market St
Johnstown, PA 15901-1628
Mailing address
3759 Business Route 220
Bedford, PA 15522
Phone (814) 623-1212
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294617600000",
"number": "1952605693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3759 BUSINESS ROUTE 220",
"city": "BEDFORD",
"state": "PA",
"postal_code": "15522",
"telephone_number": "814-623-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 MARKET ST",
"city": "JOHNSTOWN",
"state": "PA",
"postal_code": "159011628",
"telephone_number": "814-623-1212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICODEMUS",
"first_name": "KELLY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-10",
"last_updated": "2011-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.