Healthcare Provider Details

I. General information

NPI: 1972694248
Provider Name (Legal Business Name): KELLY BURKHOUSE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PINE ST STE 3
JAMESTOWN NY
14701-5331
US

IV. Provider business mailing address

3787 WESTMAN RD
BEMUS POINT NY
14712-9511
US

V. Phone/Fax

Practice location:
  • Phone: 716-499-9245
  • Fax:
Mailing address:
  • Phone: 716-499-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS008930L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: