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DR. SHAY JUNIPER KELLY PH.D.
NPI 1053902387
Counselor - Mental Health in Portland, OR

Active since January 29, 2021PECOS EnrolledAccepts Medicare Assignment
3700 N WILLIAMS AVE, PORTLAND, OR 97227(503) 281-4852 Get Directions Write a Review

NPPES record last updated: January 15, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 13, 2024, Jan 29, 2021 (2 updates tracked since 2021).

About Dr. Shay Juniper Kelly Ph.d. NPPES

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

DR. SHAY JUNIPER KELLY PH.D. (NPI 1053902387) is an individual mental health provider in Portland, Oregon and active in the NPI registry since January 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1053902387
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameDR. SHAY JUNIPER KELLYCredential: PH.D.
Location Address3700 N WILLIAMS AVEPortland, OR 97227-1441
Mailing Address3700 N Williams AvePortland, OR 97227-1441 · (503) 281-4852
Phone(503) 281-4852
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateJanuary 29, 2021
Last NPPES UpdateJanuary 15, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 15, 2025
✔ NPI 1053902387 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
3700 N WILLIAMS AVE, Portland, OR 97227
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shay Juniper Kelly Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9739644394
PECOS Enrollment IDI20260723003715
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Shay Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Portland Psychotherapy Clinic
Same address
Mental Health (Including Community Mental Health Center)
3700 N WILLIAMS AVE
Portland, OR 97227
  • Reassigned Medicare billing, Oregon enrollment
  • 5 clinicians in this Medicare group
NPI 1063626315 (503) 281-4852

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

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

PORTLAND PSYCHOTHERAPY CLINIC
Clinic/Center (Mental Health (Including Community Mental Health Center))
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852
DR. EMILY CATHERINE STASKO MPH, PHD
Psychologist (Clinical)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852
NADIA JAFARI PHD
Psychologist (Clinical)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852
TAYLOR CORRINE COATS MA
Counselor (Mental Health)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852
MOLLY BOWMAN MS, LPC
Counselor (Mental Health)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 766-5282
PRIYADARSHANI FLORENCE LOESS PH.D.
Psychologist (Clinical)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852
VICTORIA WARD PSY.D.
Counselor (Mental Health)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852
JONAH STABINSKI MSW
Social Worker (Clinical)
3700 N WILLIAMS AVE
PORTLAND, OR 97227
Multnomah County (503) 281-4852

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 Shay Kelly's NPI number?

The NPI number for Shay Kelly is 1053902387. It was assigned to this individual provider in the NPPES registry on January 29, 2021.

Where is Shay Kelly located?

Shay Kelly practices at 3700 N Williams Ave, Portland, OR 97227. The listed phone number is (503) 281-4852.

What is Shay Kelly's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Shay Kelly enrolled in Medicare?

Yes. Shay Kelly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Shay Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shay Kelly reassigns Medicare benefits to Portland Psychotherapy Clinic (Portland, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shay Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shay Kelly accept?

Health plans from PacificSource Health Plans list Shay Kelly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shay Kelly was last updated on January 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.