DR. KELLY MARK PSYD
NPI 1043561285
Psychologist in Bellevue, WA

Active since September 27, 2012Opted out of Medicare · through Jan 5, 2027
330 112TH AVE NE STE 302, BELLEVUE, WA 98004(206) 853-2409 Get Directions Write a Review

NPPES record last updated: May 24, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Kelly Mark Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY MARK PSYD (NPI 1043561285) is an individual psychologist in Bellevue, Washington, licensed in Washington (PY60781335) and active in the NPI registry since September 2012. She has opted out of Medicare through January 5, 2027 and remains eligible to order and refer and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1043561285
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. KELLY MARKCredential: PSYD
Location Address330 112TH AVE NE STE 302Bellevue, WA 98004
Mailing Address4601 121st Ave SeBellevue, WA 98006-2827 · (062) 853-2409
Sole ProprietorNo
Enumeration DateSeptember 27, 2012
Last NPPES UpdateMay 24, 2018
NPI 1043561285 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in WA · PY60781335
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
330 112TH AVE NE STE 302, Bellevue, WA 98004

Secondary Practice Locations 2

Location 1921 E Compton BlvdCompton, CA 90221-3303 · Phone (310) 668-6931
Location 224909 104th Ave SE Ste 101AKent, WA 98030-2819 · Phone (206) 853-2409

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Kelly Mark Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 5, 2019 through January 5, 2027.

Opt-Out Effective DateJanuary 5, 2019
Opt-Out In Effect ThroughJanuary 5, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
330 112TH AVE NE STE 302
BELLEVUE, WA 98004
Marriage & Family Therapist
330 112TH AVE NE STE 302
BELLEVUE, WA 98004
Counselor (Mental Health)
330 112TH AVE NE STE 302
BELLEVUE, WA 98004
Counselor (Mental Health)
330 112TH AVE NE STE 302
BELLEVUE, WA 98004

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Mark's NPI number?

The NPI number for Kelly Mark is 1043561285. It was assigned to this individual provider in the NPPES registry on September 27, 2012.

Where is Kelly Mark located?

Kelly Mark practices at 330 112th Ave NE Ste 302, Bellevue, WA 98004. The listed phone number is (206) 853-2409.

What is Kelly Mark's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Kelly Mark enrolled in Medicare?

No. Kelly Mark has opted out of Medicare through January 5, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Kelly Mark was last updated on May 24, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.