| Organization Name: | KELLY K GREENE PC |
| NPI Number: | 1003950536 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLY K GREENE (PRESIDENT) |
| Mailing Address: | 921 W 11th St Ste 1w Traverse City |
| State: | MI US |
| Postal Code: | 496843002 |
| Phone Number: | 2319299040 |
| Fax Number: | 2319295586 |
| NPI Enumeration Date: | 02/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |