NPIMap

Organization Active NPI

Modern Wellness Family Counseling, LLC

  • Marriage & Family Therapist
  • Spartanburg, SC
National Provider Identifier
1972146611
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
MODERN WELLNESS FAMILY COUNSELING, LLC
Practice address
945 E Main St Ste 5
Spartanburg, SC 29302-2119
Phone
(864) 383-9002
Fax
(864) 383-9011
NPI assigned
Oct 25, 2019
Last updated
Jan 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Authorized official

Name
Kelly Kennedy, PHD, LMFT/S, RPT/S
Title
Owner
Phone
(864) 680-6152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X Primary

Addresses

Primary practice location

945 E Main St Ste 5
Spartanburg, SC 29302-2119

Mailing address

945 E Main St Ste 5
Spartanburg, SC 29302-2119
Phone (864) 383-9002

Other practice location 1

25 Woods Lake Rd Ste 600
Greenville, SC 29607-2766
Phone (864) 383-9002

Other identifiers 2

IdentifierTypeStateIssuer
LT1083MedicaidSC
GP9435MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240628000879 SC Part B Supplier - Clinic/Group Practice 2860936044 Receives reassigned benefits from 1 practitioner
Practice locations: Greenville, SC; Spartanburg, SC

National Provider Directory

National Provider Directory

Locations

25 Woods Lake Rd
Ste 600
Greenville, SC 29607
Phone (864) 383-9002

5 Independence Pt
Ste 120
Greenville, SC 29615
Phone (864) 323-9002

811 E Main St
Ste B
Spartanburg, SC 29302
Phone (540) 529-7498

945 E Main St
Ste 5
Spartanburg, SC 29302
Phone (864) 383-9002

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1972146611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 E MAIN ST STE 5",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293022119",
            "telephone_number": "864-383-9002",
            "fax_number": "864-383-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 E MAIN ST STE 5",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293022119",
            "telephone_number": "864-383-9002",
            "fax_number": "864-383-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Woods Lake Rd Ste 600",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296072766",
            "country_code": "US",
            "telephone_number": "864-383-9002",
            "fax_number": "864-383-9011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MODERN WELLNESS FAMILY COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-680-6152",
        "authorized_official_credential": "PHD, LMFT/S, RPT/S"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LT1083",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP9435",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.