Kelly Jurae Banks Brown, PSYD
Individual provider Active NPI Clinical Psychologist · Marietta, GA
NPI 1851979975 · NPPES record last updated Apr 17, 2025
Key facts
- NPI
- 1851979975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY004757 (GA)
- Practice address
- 600 Village Trace NE
BLDG 23, Suite 100
Marietta, GA 30067 - Phone
- (770) 971-3303
- NPI assigned
- Mar 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY004757 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DWW Psychological Services, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY004757 | GA | Yes |
Addresses
Primary practice location
600 Village Trace NE
BLDG 23, Suite 100
Marietta, GA 30067
Mailing address
4611 River Hill Cir
Ellenwood, GA 30294-1884
Phone (678) 920-1151
Other providers in Marietta, GA
- Bamp Clinics Georgia, LLC
- Brady James Flores Banares
- Kiran Bandali
- Svetlana Banegas
- Jennifer Tran Banh
- Banks Chiropractic Center, PC
- Anna K. Banks
- Iris Waldon Banks
- Ladajah A Banks
- Stephen A Bankston
All providers in Marietta, GA · Clinical Psychologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.