T. K. Kelso, Psy.D, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35S1002377 Issued in NJ

Legal business name

T. K. KELSO, PSY.D, LLC

Practice address

420 Boulevard, Suite 208
Mountain Lakes, NJ 07046-1742

Phone

(973) 299-2888

Fax

(973) 299-2876

NPI assigned

Sep 19, 2008

Last updated

Dec 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Theresa K Kelso, PSY.DNPI 1083797682

Title

Owner

Phone

(973) 299-2888

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theresa K Kelso, PSY.D

  • Clinical Psychologist
  • Mountain Lakes, NJ
  • NPI 1083797682
  Authorized official Same address or phone
• Barbara Brennan Ferguson, PHD APN C

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Summit, NJ
  • NPI 1326058595
  NPD (past)

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

{
    "created_epoch": "1221782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230508800000",
    "number": "1033369699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD, SUITE 208",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461742",
            "telephone_number": "973-299-2888",
            "fax_number": "973-299-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD, SUITE 208",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461742",
            "telephone_number": "973-299-2888",
            "fax_number": "973-299-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T. K. KELSO, PSY.D, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-19",
        "last_updated": "2008-12-29",
        "status": "A",
        "authorized_official_last_name": "KELSO",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-299-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35S1002377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Mountain Lakes, NJ
• Providers in Mountain Lakes, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; 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.