Basic Information
| Provider Information | |||||||||
| NPI: | 1073671475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEALEY | ||||||||
| FirstName: | KELLY-LYNNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 377 MDOS | ||||||||
| Address2: | 2050A SECOND ST SE | ||||||||
| City: | KIRTLAND AFB | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871170001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058463305 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6541 SPECKER AVE BLDG 1830 | ||||||||
| Address2: | |||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0003729 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.