Provider Demographics
NPI:1548331747
Name:CONLEE, KEVIN MICHAEL (PHD HSPP)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:CONLEE
Suffix:
Gender:M
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SAINT ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:46124-9226
Mailing Address - Country:US
Mailing Address - Phone:812-526-0989
Mailing Address - Fax:812-526-0991
Practice Address - Street 1:206 N GRANT ST
Practice Address - Street 2:
Practice Address - City:EDINBURGH
Practice Address - State:IN
Practice Address - Zip Code:46124-1214
Practice Address - Country:US
Practice Address - Phone:812-526-0989
Practice Address - Fax:812-526-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040209103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN381650Medicare ID - Type UnspecifiedPSYCHOLOGIST