Provider Demographics
NPI:1386801082
Name:FORYS, KELLY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:FORYS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ENGLISH RUN CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-8847
Mailing Address - Country:US
Mailing Address - Phone:310-271-7876
Mailing Address - Fax:
Practice Address - Street 1:12 GALLOWAY AVE
Practice Address - Street 2:SUITE 2F
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4931
Practice Address - Country:US
Practice Address - Phone:410-271-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04289103TC0700X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth