Provider Demographics
NPI:1588769616
Name:OLMSTEAD, KELLY MURPHY (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MURPHY
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5523
Mailing Address - Country:US
Mailing Address - Phone:512-930-0884
Mailing Address - Fax:512-931-9413
Practice Address - Street 1:903 FOREST ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5523
Practice Address - Country:US
Practice Address - Phone:512-930-0884
Practice Address - Fax:512-931-9413
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24080103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035231201Medicaid
TX00P04PMedicare PIN