SEAN KELLY (NPI# 1821456559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821456559 |
| Entity Type | Individual |
| Full Name | SEAN KELLY |
| Credential | CADC I, CRM |
| Practice Address |
10564 Se Washington Street Portland OR 97216 |
| Mailing Address |
2318 Ne Martin Luther King Jr Blvd Portland OR 97212-3715 |
| Practice Telephone | 9718060571 |
| Mailing Telephone | 5033358611 |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2020-08-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
20-07-07 | OR | Behavioral Health & Social Service Providers |
| N | 175T00000X | Peer Specialist | 16-CRM-008 | OR | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326659202 | Sean Michael Kelly | Counselor | 1407 Dellwood Dr, Louisville, KY 40216-4070 | 2020-08-13 |
| 1811510894 | Sean Kelly | Registered Nurse | 530 Virginia Dr, Lake Worth, FL 33461-5751 | 2020-05-25 |
| 1396275327 | Sean Brett Kelly | Dentist | 13590b North Meridian Street, 101, Carmel, IN 46032-1409 | 2017-06-13 |
| 1073058582 | Sean Kelly | Physician Assistant | Cmr 411 Box 2507, Apo, AE 09112-0026 | 2016-12-20 |
| 1326499088 | Sean Kelly | Internal Medicine | 2401 Laura Cir, Papillion, NE 68046-4216 | 2016-06-23 |
| 1013367069 | Sean Kelly | Psychologist | 2527 W Colorado Ave Ste 208, Colorado Springs, CO 80904-3075 | 2016-06-20 |
| 1346660735 | Sean Kelly | Occupational Therapist | 556 Bay Rd, South Easton, MA 02375-1415 | 2014-04-24 |
| 1063851509 | Sean Michael Kelly | Internal Medicine | 606 Beech St, Township of Washington, NJ 07676-4332 | 2013-06-18 |
| 1154663607 | Sean Patrick Kelly | Orthopaedic Surgery | 55 Fruit St # 125n-260, Boston, MA 02114 | 2013-03-22 |
| 1952600165 | Sean C Kelly | Pathology | 364 13th St Apt 3, Brooklyn, NY 11215-7334 | 2011-03-28 |
| Street Address |
10564 SE WASHINGTON STREET |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| 1689078529 | Laurie Huffman | Counselor | 10564 Se Washington Strret, Portland, OR 97216 | 2014-10-21 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477163657 | Kevin Charles Reiser | Counselor | 2318 Ne Martin Luther King Blvd, Portland, OR 97212-3715 | 2020-08-03 |
| 1881203628 | Beau Curtiss | Counselor | 7916 Se Foster Rd Ste 203, Portland, OR 97206-4289 | 2020-07-28 |
| 1851916886 | Jonathan Cross | Counselor | 49 Montrose Ave Apt 3, Portland, ME 04103-2442 | 2020-06-16 |
| 1639703960 | Elizabeth Ann Anderson | Counselor | 1820 Sw Vermont St Ste J, Portland, OR 97219-1945 | 2020-02-25 |
| 1194356618 | Deforrest Kwesi Jackson | Counselor | 122 Ne 122nd Ave Ste 200, Portland, OR 97230-2103 | 2020-02-03 |
| 1760012942 | Jesse Decker | Counselor | 7015 N Boston Ave, Portland, OR 97217-5711 | 2020-01-16 |
| 1740829076 | Ryan Christianson | Counselor | 2707 Ne Flanders St, Portland, OR 97232-3159 | 2020-01-03 |
| 1083264477 | Kayla Rose Paris | Counselor | 420 Cumberland Ave, Portland, ME 04101-2823 | 2019-09-17 |
| 1275193260 | Anna Khval | Counselor | 1500 Se 122nd Ave, Portland, OR 97233-1207 | 2019-06-20 |
| 1841855301 | Portland Opioid Health Home | Counselor | 48 Free St., Mezzanine Level, Portland, ME 04101 | 2019-05-09 |
| Find all providers in PORTLAND | ||||
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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.