Provider Demographics
NPI:1629276340
Name:BOYCE, KELLY BREEN (PSYD,)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BREEN
Last Name:BOYCE
Suffix:
Gender:F
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 GREENWOOD CLFS
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2821
Mailing Address - Country:US
Mailing Address - Phone:704-334-0524
Mailing Address - Fax:704-334-0524
Practice Address - Street 1:1116 GREENWOOD CLFS
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2821
Practice Address - Country:US
Practice Address - Phone:704-334-0524
Practice Address - Fax:704-334-0524
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6556101YP2500X
NC1353106H00000X
NC3780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist