Katherine T. Kelly, PH.D., LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2729 Issued in NC

Legal business name

KATHERINE T. KELLY, PH.D., LLC

Practice address

1001 Reynolda Rd
Stockton Cottage
Winston Salem, NC 27104-3245

Phone

(336) 406-8431

Fax

(336) 723-1411

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Katherine T Kelly, PH. D.NPI 1407822372

Title

Psychologist, Director

Phone

(336) 406-8431

Specialties & licenses 1

Addresses

Other names 1

• Branches Holistic Health and Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katherine T. Kelly, PH.D.

  • Clinical Psychologist
  • Winston-Salem, NC
  • NPI 1407822372
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902916653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 REYNOLDA RD",
            "address_2": "STOCKTON COTTAGE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043245",
            "telephone_number": "336-406-8431",
            "fax_number": "336-723-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 REYNOLDA RD",
            "address_2": "STOCKTON COTTAGE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043245",
            "telephone_number": "336-406-8431",
            "fax_number": "336-723-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHERINE T. KELLY, PH.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PSYCHOLOGIST, DIRECTOR",
        "authorized_official_telephone_number": "336-406-8431",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH. D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Branches Holistic Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen Claudia Kastler, ACNP-BC
• Taylor Jordan Kastor, PA-C
• Marie Joanne Kaswandik, MA, LPC
• Kate Washburn Counseling, PLLC
• Katherine R Stanley
• Charles Peter Katopes III, M.D.
• Adam Judd Katz, MD
• Daniel Katz
• Jane Alexis Katz
• Levi Kauffman, M.D.

• Psychologist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.