Alyssa Ellis Killebrew, PH.D.
Individual provider Active NPI Clinical Psychologist · Ridgeland, MS
NPI 1306130125 · NPPES record last updated Dec 20, 2024
Key facts
- NPI
- 1306130125
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 54946 (MS)
- Practice address
- 241 Sunnybrook Rd
Ridgeland, MS 39157-2206 - Phone
- (601) 624-5912
- NPI assigned
- Jun 9, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Killebrew Psychological Services LLC
Practice addresses (Care Compare)
210 W Jackson St
Ridgeland, MS 39157-2312
Phone (769) 231-9414
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141125001874 | MS | Practitioner - Clinical Psychologist | 1052633294 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54946 | MS | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Essential Touchtones | Clinical | Current | Accepting new patients |
Locations
210 W Jackson St
Ridgeland, MS 39157
Phone (601) 672-3841
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 54946 | MS | Yes |
Addresses
Primary practice location
241 Sunnybrook Rd
Ridgeland, MS 39157-2206
Mailing address
210 W Jackson St
Ridgeland, MS 39157-2312
Phone (601) 750-6102
Other practice location 1
133 Berry Ln
Madison, MS 39110-8616
Phone (601) 750-6102
Other practice location 2
210 W Jackson St
Ridgeland, MS 39157-2312
Phone (601) 750-6102
Other names
- Alyssa E. Killebrew
Other providers in Ridgeland, MS
- Laurel Elizabeth Kett
- Jaida Key
- Lenora Keys
- Avani Hiralal Khatri
- Killebrew Psychological Services, LLC
- Michelle T Killebrew
- John Michael Kimbriel
- Jennifer Kimbrough
- Maggie Kimler
- Kinetix Group LLC
All providers in Ridgeland, MS · Clinical Psychologist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.