Kelly Jean Myers, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301013649 Issued in MI

Practice address

30400 Telegraph Rd
Ste 331
Bingham Farms, MI 48025-4573

Phone

(248) 645-5960

NPI assigned

Oct 31, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510704000000",
    "number": "1750560231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W LONG LAKE RD",
            "address_2": "#230",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483022056",
            "telephone_number": "248-752-7453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30400 TELEGRAPH RD",
            "address_2": "STE 331",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254573",
            "telephone_number": "248-645-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2017-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "680F389730",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsey Paige Murray
• Jack Muschong
• Bilal Mustaquim
• Mominah Mustaquim
• My Second Home Pediatrics PLLC
• Scott Myers, CRNA
• Rhiannon Joy Nadratowski
• Cynthia Nagel, CRNA
• Debra Nagy, LP
• Abed Naji, NP-C

• Clinical Psychologist in Bingham Farms, MI
• Providers in Bingham Farms, 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 15, 2017; 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.