Active NPI
Kelly Moore, M.A., LLP
- Clinical Psychologist
- Clarkston, MI
National Provider Identifier
1558530634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6361005383
- Practice address
- 6549 Town Center Dr Ste a
Clarkston, MI 48346-4824 - Phone
- (800) 395-3223
- NPI assigned
- Feb 22, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6361005383 | MI | Primary |
Addresses
Primary practice location
6549 Town Center Dr Ste a
Clarkston, MI 48346-4824
Mailing address
6549 Town Center Dr Ste a
Clarkston, MI 48346-4824
Phone (800) 395-3223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6361005383 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712707200000",
"number": "1558530634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6549 TOWN CENTER DR STE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483464824",
"telephone_number": "800-395-3223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6549 TOWN CENTER DR STE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483464824",
"telephone_number": "800-395-3223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KELLY",
"name_prefix": "Ms.",
"credential": "M.A., LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-22",
"last_updated": "2024-04-10",
"certification_date": "2024-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6361005383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.