Individual
DR. THOMAS E. KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
108 S MINNESOTA AVE STE 102, SAINT PETER, MN 56082-2557
(507) 484-2400
(507) 934-5220
Mailing address
2399 ARIEL ST N, SUITE D, MAPLEWOOD, MN 55109-2203
(651) 770-1311
(651) 770-1879
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
00018
MN
101YP2500X
Professional Counselor
00871
IA
101YP2500X
Professional Counselor
180-003674
IL
101YP2500X
Professional Counselor
3386-125
WI
103TC0700X
Clinical Psychologist
Primary
LP5043
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972607562
—
MN
Enumeration date
09/12/2006
Last updated
03/17/2018
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