KELLI TILLQUIST (PSYD) – Mental Health Counselor, NPI 1619539947
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
113 PSYCHIATRY in AK
Provider Addresses for KELLI TILLQUIST (PSYD)
607 Division Street
Nome, AK 97762
Phone: (907) 443-3344
Type: Location
1306 Petree St Apt 410
El Cajon, CA 920202336
Phone: (208) 859-1906
Type: Location
6348 W Emerald St
Boise, ID 837048732
Phone: (208) 302-0900
Fax: (208) 302-0955
Type: Location
PO BOX 45056
BOISE, ID 837115056
Phone: (208) 859-1906
Type: Mailing
1529 W BELMONT ST
BOISE, ID 837252336
Phone: (208) 426-2987
Type: Location
Division Street, Nome, Alaska, 99762, United States
NOME, AK 97762
Phone: (907) 443-3344
Type: Mailing
1306 PETREE ST APT 410
EL CAJON, CA 920202336
Phone: (208) 859-1906
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-08-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250821001408 | I | Psychiatry | ID | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97762)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Qualified Audiologist | ID | |
| Orthopedic Surgery | ID | |
| - | ID | |
| - | UT | |
| Family Practice | ID | |
| Physician Assistant | ID | |
| - | ID | |
| Internal Medicine | ID | |
| Family Practice | ID | |
| - | ID |
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