Active NPI
Kelley Damaris Haynes-Mendez, PSY.D.
- Clinical Psychologist
- Dallas, TX
National Provider Identifier
1942447818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33205
- Practice address
- 5090 Matilda St Apt 212
Dallas, TX 75206-4273 - Phone
- (972) 953-8947
- NPI assigned
- Jan 14, 2009
- Last updated
- Mar 18, 2020
- 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 | 33205 | TX | Primary |
Addresses
Primary practice location
5090 Matilda St Apt 212
Dallas, TX 75206-4273
Mailing address
5090 Matilda St
Dallas, TX 75206-4273
Phone (972) 953-8947
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33205 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584489600000",
"number": "1942447818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5090 MATILDA ST",
"city": "DALLAS",
"state": "TX",
"postal_code": "752064273",
"telephone_number": "972-953-8947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5090 MATILDA ST APT 212",
"city": "DALLAS",
"state": "TX",
"postal_code": "752064273",
"telephone_number": "972-953-8947"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYNES-MENDEZ",
"first_name": "KELLEY",
"middle_name": "DAMARIS",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-14",
"last_updated": "2020-03-18",
"certification_date": "2020-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "33205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.