Provider Demographics
NPI:1508131020
Name:GUYOT, KELLY MYERS (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MYERS
Last Name:GUYOT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4900 W NORFOLK RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2128
Mailing Address - Country:US
Mailing Address - Phone:757-404-1393
Mailing Address - Fax:877-861-7359
Practice Address - Street 1:4900 W NORFOLK RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2128
Practice Address - Country:US
Practice Address - Phone:757-404-1393
Practice Address - Fax:877-861-7359
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-01-9925103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst