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KELLY LYNN SAMLI MA, LMHC, ADHD-CCSP
NPI 1083112817
Counselor - Mental Health in Bothell, WA

Active since January 26, 2018Opted out of Medicare · through Apr 15, 2028
22232 17TH AVE SE STE 302, BOTHELL, WA 98021(425) 487-1005(425) 487-4884 Get Directions Write a Review

NPPES record last updated: April 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelly Lynn Samli Ma, Lmhc, Adhd-ccsp NPPES

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

KELLY LYNN SAMLI MA, LMHC, ADHD-CCSP (NPI 1083112817) is an individual mental health provider in Bothell, Washington, licensed in Washington (LH60796061) and active in the NPI registry since January 2018. She has opted out of Medicare through April 15, 2028.

NPPES Registry Identity

NPI1083112817
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKELLY LYNN SAMLICredential: MA, LMHC, ADHD-CCSP
Location Address22232 17TH AVE SE STE 302Bothell, WA 98021-7425
Mailing Address8623 Ne 24th StClyde Hill, WA 98004-2428 · (425) 463-9062
Phone(425) 487-1005
Fax(425) 487-4884
Sole ProprietorNo
Enumeration DateJanuary 26, 2018
Last NPPES UpdateApril 4, 2025
NPPES CertifiedApril 4, 2025
✔ NPI 1083112817 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in WA · LH60796061
22232 17TH AVE SE STE 302, Bothell, WA 98021
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kelly Lynn Samli Ma, Lmhc, Adhd-ccsp 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 April 15, 2024 through April 15, 2028.

Opt-Out Effective DateApril 15, 2024
Opt-Out In Effect ThroughApril 15, 2028Opt-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 9

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

LILLA COLLINGRIDGE MARIE LMHC
Counselor (Mental Health)
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-1005
DR. NANCY CROWLEY PSYD
Counselor
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-1005
KATHLEEN R STABBERT LMHC
Counselor (Mental Health)
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-1005
DR. DANIEL D. HARTMAN PSYD
Psychologist (Clinical)
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-1005
NICOLE CHO BA, MSC, LMHC
Counselor (Mental Health)
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-1005
HARTMAN THERAPY GROUP PLLC
Counselor (Mental Health)
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 319-6477
ERIK DAVID NELSON
Psychologist
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-3885
ARIEL MACKENZIE SOULE
Counselor (Mental Health)
22232 17TH AVE SE STE 302
BOTHELL, WA 98021
Snohomish County (425) 487-3885

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 Samli's NPI number?

The NPI number for Kelly Samli is 1083112817. It was assigned to this individual provider in the NPPES registry on January 26, 2018.

Where is Kelly Samli located?

Kelly Samli practices at 22232 17th Ave SE Ste 302, Bothell, WA 98021. The listed phone number is (425) 487-1005.

What is Kelly Samli's specialty?

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

Is Kelly Samli enrolled in Medicare?

No. Kelly Samli has opted out of Medicare through April 15, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Kelly Samli accept?

Health plans from Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Kelly Samli 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 Kelly Samli was last updated on April 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.