Laura Kellison, Psy,.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

19863 Issued in CA

Legal business name

LAURA KELLISON, PSY,.D.

Practice address

115 Liberty St
Suite 4
Petaluma, CA 94952-2326

Phone

(707) 364-9388

NPI assigned

Feb 18, 2011

Organization subpart

No

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

Authorized official

Name

Laura Kellison, PSY.D.NPI 1760538896

Title

Clinical Psychologist

Phone

(707) 364-9388

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura J.S. Kellison, PSY.D.

  • Psychologist
  • Petaluma, CA
  • NPI 1760538896
  NPD (past) Authorized official

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1154628634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 LIBERTY ST",
            "address_2": "SUITE 4",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522326",
            "telephone_number": "707-364-9388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 LIBERTY ST",
            "address_2": "SUITE 4",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522326",
            "telephone_number": "707-364-9388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURA KELLISON, PSY,.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-18",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "KELLISON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "707-364-9388",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "19863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Ryan Larsen, HS3
• Jim A. Larsen, D.C.
• Steven Joel Laska, MFT
• Latazt LLC
• Nicholas Robert Lau
• Ronald M Lavigna, DPM
• Shane Lavin
• Tanoya Law
• Colleen Lawrence
• Suzanne Carol Lawrence, RN, MSN, FNP

• Clinical Psychologist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; 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.