Healthcare Provider Details

I. General information

NPI: 1588769616
Provider Name (Legal Business Name): KELLY MURPHY OLMSTEAD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 FOREST ST
GEORGETOWN TX
78626-5523
US

IV. Provider business mailing address

903 FOREST ST
GEORGETOWN TX
78626-5523
US

V. Phone/Fax

Practice location:
  • Phone: 512-930-0884
  • Fax: 512-931-9413
Mailing address:
  • Phone: 512-930-0884
  • Fax: 512-931-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24080
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: