Kelatess PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006835 Issued in MI

Legal business name

KELATESS PC

Practice address

1441 E Maple Ave
Burton, MI 48529-2059

Phone

(810) 820-6265

NPI assigned

Jul 11, 2006

Last updated

Nov 30, 2016By 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. Matthew P. Dickson, PHDNPI 1437321502

Title

President

Phone

(810) 606-1099

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Matthew Price Dickson, PH.D.

  • Clinical Psychologist
  • Burton, MI
  • NPI 1437321502
  Authorized official Same address or phone

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1659305860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7382 MOHANSIC DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013552",
            "telephone_number": "810-606-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 E MAPLE AVE",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485292059",
            "telephone_number": "810-820-6265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELATESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-606-1099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "680F33159",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jori Anne July, CNP
• Dianne Junior, NP
• Paul H Karr Jr., MD
• Gurpreet Kaur
• Kirpal Kaur
• Michael Kelly
• Ashley Marie Kennedy
• Ronald Mark Kesemeyer, RPH
• Zaina Khal
• Khaled M Shukairy MD PC

• Clinical Psychologist in Burton, MI
• Providers in Burton, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.