Healthcare Provider Details

I. General information

NPI: 1114223179
Provider Name (Legal Business Name): KELLY HALE COURT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 555677
CAMP PENDLETON CA
92055-5677
US

IV. Provider business mailing address

PSC 561 BOX 2736
FPO AP
96310-0028
US

V. Phone/Fax

Practice location:
  • Phone: 609-284-4863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number747
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: