Provider Demographics
NPI:1932164597
Name:BASKIND, KELLY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:BASKIND
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 1:5565 YELLOWCRESS DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8011
Mailing Address - Country:US
Mailing Address - Phone:989-249-1112
Mailing Address - Fax:
Practice Address - Street 1:4901 TOWNE CTR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2841
Practice Address - Country:US
Practice Address - Phone:989-921-5715
Practice Address - Fax:989-921-5960
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010317103TC0700X, 103T00000X
MI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P21010Medicare ID - Type UnspecifiedMEDICARE