Provider Demographics
NPI:1386295277
Name:KELLEY, CHRISTOPHER E (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 S DAYTON ST STE 3650
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6135
Mailing Address - Country:US
Mailing Address - Phone:720-695-3369
Mailing Address - Fax:720-780-2069
Practice Address - Street 1:6535 S DAYTON ST STE 3650
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6135
Practice Address - Country:US
Practice Address - Phone:720-695-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYC13966103T00000X
COPSY5175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPSYC.0013966Medicaid