Active NPI
Carrie Kelley, PSYD
- Clinical Psychologist
- Salt Lake City, UT
National Provider Identifier
1780737528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 70077562501
- Practice address
- 275 E South Temple
Suite 101
Salt Lake City, UT 84111-1247 - Phone
- (801) 999-0639
- Fax
- (800) 136-4143
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 70077562501 | UT | Primary |
Addresses
Primary practice location
275 E South Temple
Suite 101
Salt Lake City, UT 84111-1247
Mailing address
275 E South Temple
Suite 101
Salt Lake City, UT 84111-1247
Phone (801) 999-0639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081224000083 | UT | Practitioner - Clinical Psychologist | 9537221692 | Practice locations: Salt Lake City, UT |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70077562501 | UT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258070400000",
"number": "1780737528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 E SOUTH TEMPLE",
"address_2": "SUITE 101",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841111247",
"telephone_number": "801-999-0639",
"fax_number": "800-136-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 E SOUTH TEMPLE",
"address_2": "SUITE 101",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841111247",
"telephone_number": "801-999-0639",
"fax_number": "800-136-4143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "CARRIE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2009-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "70077562501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.