Provider Demographics
NPI:1144244617
Name:KELMAN, ELLEN G (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:G
Last Name:KELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 N TATUM BLVD
Mailing Address - Street 2:200-258
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3068
Mailing Address - Country:US
Mailing Address - Phone:480-451-5558
Mailing Address - Fax:602-996-6600
Practice Address - Street 1:10165 N 92ND ST
Practice Address - Street 2:101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4558
Practice Address - Country:US
Practice Address - Phone:480-451-5558
Practice Address - Fax:602-996-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPHD3063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS04691Medicare UPIN
AZPHD3063AMedicare ID - Type UnspecifiedPART B PROVIDER NUMBER