Keely Ann Boutwell, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-17-27612 Issued in TX

Practice address

12812 Appaloosa Chase Dr
Austin, TX 78732-1971

Phone

(512) 636-5467

NPI assigned

Sep 27, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506902400000",
    "number": "1063921526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 TRINITY HILLS DR APT 3110",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787374786",
            "telephone_number": "512-585-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12812 APPALOOSA CHASE DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787321971",
            "telephone_number": "512-636-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTWELL",
        "first_name": "KEELY",
        "middle_name": "ANN",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2017-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-17-27612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sebastian Bourgeois, LPC
• Courtney Lynn Bourlon, LCSW
• Elise Boutin, MA, LPC ASSOCIATE
• Evelyn Amanda Boutot, PH.D.
• Jacqueline Boutros, MSW, LCSW
• Kimberly Anne Bovet
• Sarah Fulton Bovio, MD
• Barry Lynn Bowden, DDS
• Emily Bowden, RN, FNP-C
• Audrey Bowe, MA

• Behavior Analyst in Austin, TX
• Providers in Austin, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.