Provider Demographics
NPI:1073759262
Name:MCKELVIE, JOHN N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:MCKELVIE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41990 COOK ST
Mailing Address - Street 2:BLDG F, SUITE 1002
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6100
Mailing Address - Country:US
Mailing Address - Phone:760-423-1323
Mailing Address - Fax:760-341-5622
Practice Address - Street 1:41990 COOK ST
Practice Address - Street 2:BLDG F, SUITE 1002
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6100
Practice Address - Country:US
Practice Address - Phone:760-423-1323
Practice Address - Fax:760-341-5622
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY 3425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical