MEDICARE: DR. KELLY M BASKIND PH.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301010317	MI
2	103T00000X	Psychologist	6301010317	MI
3	103TC1900X	Counseling Psychologist		MI

General Provider Information

NPI Number	:	1932164597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY M BASKIND PH.D.

Provider Business Mailing Address
First Line	:	5565 YELLOWCRESS DR
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-8011
Country	:	US
Telephone Number	:	989-249-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 TOWNE CTR
Second Line	:	SUITE 115
City	:	SAGINAW
State	:	MI
Zip	:	48604-2841
Country	:	US
Telephone Number	:	989-921-5715
Fax Number	:	989-921-5960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/11/2025

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