MEDICARE: KEYSTONE PSYCHOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649452608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE PSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	2131 S WEBSTER AVE
Second Line	:	SUITE 105
City	:	GREEN BAY
State	:	WI
Zip	:	54301-2288
Country	:	US
Telephone Number	:	920-366-7792
Fax Number	:	920-227-4117

Provider Business Practice Location Address
First Line	:	2131 S WEBSTER AVE
Second Line	:	SUITE 105
City	:	GREEN BAY
State	:	WI
Zip	:	54301-2288
Country	:	US
Telephone Number	:	920-366-7792
Fax Number	:	920-227-4117

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. KEVIN WAYNE MILLER
Credential	:	PHD
Telephone Number	:	920-366-7792

Provider Enumeration Date	:	12/02/2007
Last Update Date	:	11/04/2010

Similar Medicare Providers

1407920283 — DR. KEVIN WAYNE MILLER PHD
Practice Location Address:

2131 S WEBSTER AVE , SUITE 105
GREEN BAY, WI
54301-2288

Practice Phone: 920-366-7792
Practice Fax:

1891051363 — ASPEN PSYCHOLOGY LLC
Practice Location Address:

2131 S WEBSTER AVE , SUITE 105
GREEN BAY, WI
54301-2288

Practice Phone: 920-544-6712
Practice Fax: 920-372-1380

1366797656 — MRS. JODY LOUISE KERSHNER MT-BC
Practice Location Address:

2288 FOREST GREEN CT
MARIETTA, GA
30062-2503

Practice Phone: 404-308-7057
Practice Fax: 770-977-7057

1194315994 — PATRICIA MOO YOESTING PTA
Practice Location Address:

2288 GREEN MEADOWS LN
BUDA, TX
78610-9002

Practice Phone: 214-440-8882
Practice Fax:

1639050321 — CANDICE LYNN MOREAU
Practice Location Address:

744 S WEBSTER AVE
GREEN BAY, WI
54301-3505

Practice Phone: 920-433-3617
Practice Fax:

1316338866 — KELLY DALLAIRE LPC
Practice Location Address:

425 S ADAMS ST STE 205
GREEN BAY, WI
54301-4117

Practice Phone: 920-737-7695
Practice Fax:

Directions to “KEYSTONE PSYCHOLOGY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.