MISS KELLY MARIE GRANGER PSY.D.
NPI 1164686515
Psychologist in Tustin, CA

Active since July 15, 2008Opted out of Medicare · through Oct 1, 2027
222 W MAIN ST STE 101, TUSTIN, CA 92780(949) 381-1519 Get Directions Write a Review

NPPES record last updated: May 29, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Miss Kelly Marie Granger Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS KELLY MARIE GRANGER PSY.D. (NPI 1164686515) is an individual psychologist in Tustin, California, licensed in California (PSY28523) and active in the NPI registry since July 2008. She has opted out of Medicare through October 1, 2027.

NPPES Registry Identity

NPI1164686515
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameMISS KELLY MARIE GRANGERCredential: PSY.D.
Location Address222 W MAIN ST STE 101Tustin, CA 92780
Mailing Address222 W Main St Ste 101Tustin, CA 92780-7711 · (949) 381-1519
Sole ProprietorNo
Enumeration DateJuly 15, 2008
Last NPPES UpdateMay 29, 2018
NPI 1164686515 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY28523
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
222 W MAIN ST STE 101, Tustin, CA 92780

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Miss Kelly Marie Granger Psy.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2023 through October 1, 2027.

Opt-Out Effective DateOctober 1, 2023
Opt-Out In Effect ThroughOctober 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
222 W MAIN ST STE 101
TUSTIN, CA 92780
Marriage & Family Therapist
222 W MAIN ST STE 101
TUSTIN, CA 92780
Marriage & Family Therapist
222 W MAIN ST STE 101
TUSTIN, CA 92780
Counselor (Mental Health)
222 W MAIN ST STE 101
TUSTIN, CA 92780
Clinic/Center (Mental Health (Including Community Mental Health Center))
222 W MAIN ST STE 101
TUSTIN, CA 92780

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Granger's NPI number?

The NPI number for Kelly Granger is 1164686515. It was assigned to this individual provider in the NPPES registry on July 15, 2008.

Where is Kelly Granger located?

Kelly Granger practices at 222 W Main St Ste 101, Tustin, CA 92780. The listed phone number is (949) 381-1519.

What is Kelly Granger's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Kelly Granger enrolled in Medicare?

No. Kelly Granger has opted out of Medicare through October 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kelly Granger was last updated on May 29, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.