Provider Demographics
NPI:1023591864
Name:BOYD, RIELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:RIELLY
Middle Name:
Last Name:BOYD
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 1:312 W FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1419
Mailing Address - Country:US
Mailing Address - Phone:480-430-0553
Mailing Address - Fax:
Practice Address - Street 1:1515 E CEDAR AVE STE E-2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1646
Practice Address - Country:US
Practice Address - Phone:928-714-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ004992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty