Provider Demographics
NPI:1407060122
Name:MONTEL, KELLY HUOTT (PHD ,)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HUOTT
Last Name:MONTEL
Suffix:
Gender:F
Credentials:PHD ,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 BANYAN BOULEVARD CIR NW
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6326
Mailing Address - Country:US
Mailing Address - Phone:561-213-1373
Mailing Address - Fax:561-241-3174
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:#340
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-213-1373
Practice Address - Fax:561-241-3174
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5091Medicare ID - Type Unspecified