Provider Demographics
NPI:1366010357
Name:HEARD, KELLY BONNEAU
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BONNEAU
Last Name:HEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 BAY MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7225
Mailing Address - Country:US
Mailing Address - Phone:214-707-4873
Mailing Address - Fax:
Practice Address - Street 1:1706 TENNISON PKWY STE 140
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8018
Practice Address - Country:US
Practice Address - Phone:817-808-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist