Kelly Ann Maas, MSE, LPC, SAS

Primary specialty

CounselorTaxonomy code 101Y00000X

License

3243-125 Issued in WI

Practice address

1415 East Green Bay St.,
Ste 191 Synergy Counseling Services, SC
Shawano,, WI 54166-3881

Phone

(715) 526-5466

Fax

(715) 526-5545

NPI assigned

Oct 17, 2006

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

Other identifiers 2

Other names 1

• Kelly Ann Kitchens Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Synergy Counseling Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shawano, WI
  • NPI 1033127444

  Counselor

  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252022400000",
    "number": "1992886162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 EAST GREEN BAY ST.,",
            "address_2": "STE 191 SYNERGY COUNSELING SERVICES, SC",
            "city": "SHAWANO,",
            "state": "WI",
            "postal_code": "541663881",
            "telephone_number": "715-526-5466",
            "fax_number": "715-526-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 EAST GREEN BAY ST.,",
            "address_2": "STE 191 SYNERGY COUNSELING SERVICES, SC",
            "city": "SHAWANO,",
            "state": "WI",
            "postal_code": "541663881",
            "telephone_number": "715-526-5466",
            "fax_number": "715-526-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAAS",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "MSE, LPC, SAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2009-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "13230130",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "3243125",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "3243-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11681743",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40998400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "KITCHENS",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Counselor in Shawano,, WI
• Providers in Shawano,, WI by specialty
• Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; 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.