NPIMap

Organization Active NPI

Kelley Wilson Psychological Services, LLC

  • Psychologist
  • Daphne, AL
National Provider Identifier
1336989912
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
KELLEY WILSON PSYCHOLOGICAL SERVICES, LLC
Practice address
25833 State Highway 181
Daphne, AL 36526-6101
Phone
(251) 551-9470
NPI assigned
May 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Kelley Wilson, PHDNPI 1346605714
Title
Psychologist
Phone
(251) 551-9470

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

25833 State Highway 181
Daphne, AL 36526-6101

Mailing address

PO Box 650
Fairhope, AL 36533-0650
Phone (251) 551-9470

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1336989912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365330650",
            "telephone_number": "251-551-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25833 STATE HIGHWAY 181",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365266101",
            "telephone_number": "251-551-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY WILSON PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "251-551-9470",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daphne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.