Provider Demographics
NPI:1447317573
Name:BOYD, KELLY B (PSYD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:BOYD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:B
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:7718 WOOD HOLLOW DR STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1601
Mailing Address - Country:US
Mailing Address - Phone:512-279-6721
Mailing Address - Fax:512-279-6750
Practice Address - Street 1:7718 WOOD HOLLOW DR STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1601
Practice Address - Country:US
Practice Address - Phone:512-279-6721
Practice Address - Fax:512-279-6750
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035MJOtherBLUE CROSS BLUE SHIELD