Kellin, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3531 Issued in NC

Legal business name

KELLIN, PLLC

Practice address

1175 Revolution Mill Dr Ste 34L
Greensboro, NC 27405-5168

Phone

(336) 355-6206

NPI assigned

Aug 12, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Graves, PHDNPI 1922381912

Title

Owner

Phone

(336) 355-6206

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Graves, PHD

  • Clinical Psychologist
  • Greensboro, NC
  • NPI 1922381912
  Medicare reassignment Authorized official
• Kathryn Beam, LCMHCA

  • Mental Health Counselor
  • Greensboro, NC
  • NPI 1326715657
  NPD
• Jessica Matlock, LCMHC

  • Mental Health Counselor
  • High Point, NC
  • NPI 1801374731
  NPD (past)
• Katherine McAlister Wangelin, MSW, LCSW

  • Clinical Social Worker
  • Greensboro, NC
  • NPI 1740432418
  NPD (past)

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1952855413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 REVOLUTION MILL DR STE 34L",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055168",
            "telephone_number": "336-355-6206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 REVOLUTION MILL DR STE 34L",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055168",
            "telephone_number": "336-355-6206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLIN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-355-6206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3531",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Anne Kelley, LPC
• Rachelle Kelley, PHARMD
• Suzanne Marie Kelley, COTA
• Kellin Foundation
• Kellin Foundation
• Douglas Alan Kellogg, D.D.S.
• Andrew Wayne Kelly, DDS
• Chenay A Kelly
• Elizabeth Kelly
• Hailey Seaver Kelly, PHARMD

• Clinical Psychologist in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.