Provider Demographics
NPI:1851613905
Name:TAMAYO, KELLY LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 S 133RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1142
Mailing Address - Country:US
Mailing Address - Phone:402-590-2947
Mailing Address - Fax:402-590-2030
Practice Address - Street 1:4565 S 133RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1142
Practice Address - Country:US
Practice Address - Phone:402-590-2947
Practice Address - Fax:402-590-2030
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist