Healthcare Provider Details

I. General information

NPI: 1689763849
Provider Name (Legal Business Name): KELLY KENT ORR PHD, ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 HOLLOW BROOK DR SUITE 70
COLORADO SPRINGS CO
80918-1451
US

IV. Provider business mailing address

2155 HOLLOW BROOK DR SUITE 70
COLORADO SPRINGS CO
80918-1451
US

V. Phone/Fax

Practice location:
  • Phone: 719-266-5244
  • Fax: 719-266-5245
Mailing address:
  • Phone: 719-266-5244
  • Fax: 719-266-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number776
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2706
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: