Individual
KEELY ANN BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
12812 APPALOOSA CHASE DR, AUSTIN, TX 78732-1971
(512) 636-5467
Mailing address
761 TRINITY HILLS DR APT 3110, AUSTIN, TX 78737-4786
(512) 585-3686
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27612
TX
Other
Enumeration date
09/27/2017
Last updated
10/02/2017
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