MS. KELLY JEANNE MCCORMICK (NPI# 1710193727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710193727 |
| Entity Type | Individual |
| Full Name | MS. KELLY JEANNE MCCORMICK |
| Credential | LAC |
| Practice Address |
2101 Elm St N Mental Health Fargo ND 58102-2417 |
| Mailing Address |
406 8th Ave Sw Mandan ND 58554-4029 |
| Practice Telephone | 7012393700 |
| Practice Fax Number | 7012372642 |
| Mailing Telephone | 7016635454 |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
1449 | ND | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477905966 | Kelly J Mccormick | Speech-Language Pathologist | 1359 Plum Creek Dr, Bourbonnais, IL 60914-1533 | 2016-07-07 |
| 1801264528 | Kelly J Mccormick | Counselor | 8810 Torchwood Dr, Trinity, FL 34655-5333 | 2015-09-11 |
| 1851490650 | Kelly A Mccormick | Chiropractor | 5101 Old Highway 5 Ste 1, Woodstock, GA 30188 | 2006-09-21 |
| 1801431259 | Kelly Ann Mccormick | Dietitian, Registered | 10750 W Mcdowell Rd Ste A300, Avondale, AZ 85392-5963 | 2019-11-08 |
| 1790347961 | Kelly Mccormick | Counselor | 55 Dodge Rd, Getzville, NY 14068-1205 | 2019-07-08 |
| 1447815857 | Kelly Nicole Mccormick | Nurse Practitioner | 1401 Nicholasville Rd, Lexington, KY 40503-1140 | 2019-05-01 |
| 1497102784 | Kelly Alexander Mccormick | Student in an Organized Health Care Education/Training Program | 817 Princeton Ave Sw, Pob II; Suite 106, Birmingham, AL 35211-1333 | 2016-05-17 |
| 1922455328 | Kelly Mccormick | Physical Therapist | 3201 Farnam St Ste 6110, Omaha, NE 68131-3405 | 2016-05-16 |
| 1932534039 | Kelly Mccormick | Registered Nurse | 400 N Pepper Ave, Colton, CA 92324-1801 | 2013-09-08 |
| 1770867335 | Kelly Mccormick | Rehabilitation Practitioner | 2017 E 4th St, Long Beach, CA 90814-1001 | 2011-09-30 |
| Street Address |
2101 ELM ST N MENTAL HEALTH |
| City | FARGO |
| State | ND |
| Zip Code | 58102-2417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437143427 | Adam John Glazier | Internal Medicine | 2101 Elm St N, Fargo, ND 58102-2417 | 2005-09-06 |
| 1235740705 | Macy Jane Schindler | Occupational Therapist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-08-10 |
| 1497363154 | Isaac Nies | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-20 |
| 1376151597 | Paul Afanasi Polanski | Social Worker | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-14 |
| 1144848763 | Alexis Kokett | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-09 |
| 1598396459 | Leah Roethel | Dietitian, Registered | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-01-30 |
| 1619508678 | Allison Wanner | Dietitian, Registered | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-01-29 |
| 1720622822 | Nicole Marie Justice | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-10-31 |
| 1750923033 | Samantha J. Tupy | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-10-08 |
| 1639723232 | Madelyn Provost | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-07-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558991406 | N.i.a.m Brain Injury Services, LLP | Counselor | 1206 1st Ave S, Fargo, ND 58103-1747 | 2020-01-20 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1205360153 | Community Medical Services Montana-private, LLC | Counselor | 901 28th St S Ste B, Fargo, ND 58103-8743 | 2017-04-18 |
| 1962805317 | Lisa Vig | Counselor | 4720 7th Ave S Ste B, Fargo, ND 58103-7254 | 2014-09-30 |
| 1649689506 | Cara Christenson | Counselor | 505 40th St S, Suite B, Fargo, ND 58103-1184 | 2014-08-05 |
| 1215346259 | Stacey Nelson | Counselor | 4215 9th Ave S, Fargo, ND 58103-2018 | 2014-08-04 |
| 1508273418 | Robert Hansen | Counselor | 1202 23rd St S Ste 5, Fargo, ND 58103-2951 | 2014-07-14 |
| 1326469883 | Community Extended Nuclear Transitional Residence for Ex-offenders | Counselor | 123 15th St N, Fargo, ND 58102-4220 | 2013-12-30 |
| 1760765416 | Roberta J Pytlik | Counselor | 17 7th St S, Fargo, ND 58103-1800 | 2011-09-20 |
| 1891934873 | Paulette L Walker | Counselor | 1121 Westrac Dr S Ste 202, Fargo, ND 58103-2385 | 2009-02-13 |
| Find all providers in FARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.