SHELLY MARIE KENNEDY-GONZALEZ (LPC) – Mental Health Counselor, NPI 1679923320
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,199 MENTAL HEALTH COUNSELOR in OK
Provider Addresses for SHELLY MARIE KENNEDY-GONZALEZ (LPC)
112 E LAREDO PL
BROKEN ARROW, OK 740127957
Phone: (918) 227-2016
Fax: (918) 227-2016
Type: Mailing
6931 S 66th East Ave Ste 200
Tulsa, OK 741331765
Phone: (918) 379-4431
Fax: (918) 328-2380
Type: Location
23, East Ross Avenue, Sapulpa, Creek County, Oklahoma, 74066, United States
SAPULPA, OK 740666423
Phone: (918) 227-2016
Fax: (918) 227-1125
Type: Location
6931 S 66TH EAST AVE STE 200
TULSA, OK 741331765
Phone: (918) 379-4431
Fax: (918) 328-2380
Type: Mailing
2017 S ELM PL STE 104
BROKEN ARROW, OK 740127034
Phone: (918) 379-4431
Fax: (918) 328-2380
Type: Location
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: 2024-04-22
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 |
|---|---|---|---|---|
| I20240422003081 | I | Mental Health Counselor | OK | 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 74012)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | OK | |
| Mental Health Counselor | OK | |
| Clinical Social Worker | OK | |
| Mental Health Counselor | OK | |
| Mental Health Counselor | OK |
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