Kellee Clark

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

2222 N Nevada Ave
Colorado Springs, CO 80907-6819

Phone

(719) 555-5555

NPI assigned

Feb 4, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Mindfully Transforming Counseling LLC

  • Mental Health Counselor
  • Richmond, VA
  • NPI 1912737131
  NPD Authorized official

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1962094615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 BROADWAY STE 314C",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-555-5555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1942 Broadway Ste 314C",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803025233",
            "country_code": "US",
            "telephone_number": "804-616-7328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-04",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daisy Elisabeth Clark
• Dhamya Faye Louise Clark
• Douglas P Clark, MD
• Jessica Yukihiro Clark
• Jordan Leigh Clark
• Kenneth Eugene Clark, COTA
• Kiera Clark
• Lacie Clark, CAT
• Laura Clark, PHARMD, LAC, DIPL.OM
• Nathan C Clark, PTA

• Clinical Social Worker in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.