Basic Information
| Provider Information | |||||||||
| NPI: | 1447317573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOYD | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PSY.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7718 WOOD HOLLOW DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787311601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122796721 | ||||||||
| FaxNumber: | 5122796750 | ||||||||
| Practice Location | |||||||||
| Address1: | 7718 WOOD HOLLOW DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787311601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122796721 | ||||||||
| FaxNumber: | 5122796750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2007 | ||||||||
| LastUpdateDate: | 01/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 32371 | TX | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.