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

Active since January 29, 2021PECOS Enrolled
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: August 23, 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.

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
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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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shay Juniper Kelly Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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 enrollment system.

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 19 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.