Keith C Radley III, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

55982 Issued in MS

Practice address

210 Bellegrass Blvd
Hattiesburg, MS 39402-1907

Phone

(801) 860-6894

NPI assigned

Feb 25, 2016

Last updated

Feb 25, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Magnolia Behavioral Psychology, PLLC

  dba Magnolia Behavioral Psychology

  • Psychologist
  • Hattiesburg, MS
  • NPI 1033578018
  NPD

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

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1932569464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 BELLEGRASS BLVD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021907",
            "telephone_number": "801-860-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 BELLEGRASS BLVD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021907",
            "telephone_number": "801-860-6894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADLEY",
        "first_name": "KEITH",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-25",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "55982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew J Quin, PCAC
• Adam Ellington Quinn, M.D.
• Kelley Quinn, NP
• Allison Radley, DO
• Joseph Michael Radley, M.D.
• Michael J. Raggio, M.D.
• Aravind Raghavan, MD
• Charlotte McIlwain Rahaim, LPC, LMFT
• Audra Teris Rainey, MS, NCC, LPC
• Russell Craig Rainey, LPC

• Psychologist in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.