MEDICARE: KEYSTONE PSYCHOLOGICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103G00000X	Clinical Neuropsychologist
3	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1750060604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2611 KEYSTONE RD STE B3
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-7403
Country	:	US
Telephone Number	:	727-597-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 KEYSTONE RD STE B3
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-7403
Country	:	US
Telephone Number	:	727-597-0977
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LICENSED PSYCHOLOGIST
Name	:	DR. MELINA SCALLY
Credential	:	PSYD
Telephone Number	:	727-597-0977

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	10/30/2025

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