Individual
KELLY KATHLEEN GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
701 US HIGHWAY 31 S, TRAVERSE CITY, MI 49685-8016
(989) 497-2500
Mailing address
701 US HIGHWAY 31 S, TRAVERSE CITY, MI 49685-8016
(989) 497-2500
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301011602
MI
103T00000X
Psychologist
6301011602
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508810318
—
MI
Enumeration date
05/19/2006
Last updated
02/28/2020
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