Provider Demographics
NPI:1558987875
Name:SCHIRR, KELLY MOORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MOORE
Last Name:SCHIRR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 70416
Mailing Address - Street 2:ETSU DEPT OF PSYCHOLOGY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614
Mailing Address - Country:US
Mailing Address - Phone:423-439-4849
Mailing Address - Fax:423-439-7780
Practice Address - Street 1:166 DEROSIER DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-5200
Practice Address - Country:US
Practice Address - Phone:423-439-7777
Practice Address - Fax:423-438-7780
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3594103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist