Provider Demographics
NPI:1790102630
Name:ELLEN G KELMAN PHD PC
Entity Type:Organization
Organization Name:ELLEN G KELMAN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-451-5558
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:602-451-5558
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3063103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty