Active NPI
Kathleen Kelley
- Mental Health Counselor
- Williston, VT
National Provider Identifier
1962688085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 0680000352
- Practice address
- 28 Park Ave
Catamount Center, Suite 110
Williston, VT 05495 - Phone
- (802) 878-0550
- NPI assigned
- Jan 18, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 0680000352 | VT | Primary |
Addresses
Primary practice location
28 Park Ave
Catamount Center, Suite 110
Williston, VT 05495
Mailing address
124 Covington LN
Shelburne, VT 05482-6657
Phone (802) 310-1654
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0680000352 | Other | VT | LCMHC |
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 |
|---|---|---|---|
| 0680000352 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226275200000",
"number": "1962688085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 COVINGTON LN",
"city": "SHELBURNE",
"state": "VT",
"postal_code": "054826657",
"telephone_number": "802-310-1654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 PARK AVE",
"address_2": "CATAMOUNT CENTER, SUITE 110",
"city": "WILLISTON",
"state": "VT",
"postal_code": "05495",
"telephone_number": "802-878-0550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "KATHLEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-18",
"last_updated": "2008-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "0680000352",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCMHC",
"identifier": "0680000352",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Williston, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.