Active NPI
Karen Gaye Kelly
- Marriage & Family Therapist
- Portland, OR
National Provider Identifier
1982091948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- R3372
- Practice address
- 4431 SE Woodstock Blvd
Portland, OR 97206-6271 - Phone
- (503) 765-6221
- NPI assigned
- Apr 16, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R3372 | OR | |
| Marriage & Family Therapist | 106H00000X | R3372 | OR | Primary |
Addresses
Primary practice location
4431 SE Woodstock Blvd
Portland, OR 97206-6271
Mailing address
6206 SE 30TH Ave
Portland, OR 97202-8602
Phone (503) 765-6221
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 |
|---|---|---|---|
| R3372 | OR | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429142400000",
"number": "1982091948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6206 SE 30TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972028602",
"telephone_number": "503-765-6221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4431 SE WOODSTOCK BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972066271",
"telephone_number": "503-765-6221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KAREN",
"middle_name": "GAYE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-16",
"last_updated": "2015-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "R3372",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "R3372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.