Kelly K Greene PC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

KELLY K GREENE PC

Practice address

921 W 11TH St Ste 1W
Traverse City, MI 49684-3002

Phone

(231) 929-9040

Fax

(231) 929-5586

NPI assigned

Feb 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly K Greene, PSY D

Title

President

Phone

(231) 929-9040

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003950536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1024",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496016024",
            "telephone_number": "231-775-6076",
            "fax_number": "231-775-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 W 11TH ST STE 1W",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843002",
            "telephone_number": "231-929-9040",
            "fax_number": "231-929-5586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY K GREENE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-929-9040",
        "authorized_official_credential": "PSY D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Keller, LPC
• Jessica Kelley, M.A, LPC
• Jordan Paige Kelley
• Kelli Rae Kelley
• Carolynn A Kellogg, N.P.
• Jeffrey John Kelly, D.O.
• Joseph B Kelly, LPC
• Katherine Grace Kelly
• Kevin Charles Kelly, D.D.S.
• Kimberly Kelly, PSYD

• Clinical Neuropsychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Neuropsychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.