KELLY BROYLES (NPI# 1639611643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639611643 |
| Entity Type | Individual |
| Full Name | KELLY BROYLES |
| Credential | LMFT |
| Practice Address |
2200 N Patterson St Suite D Valdosta GA 31602-2597 |
| Practice Telephone | 2292441707 |
| Mailing Telephone | 2292441707 |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | MFT001514 | GA | Behavioral Health & Social Service Providers |
| Street Address |
2200 N PATTERSON ST SUITE D |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-2597 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225163884 | Sara E. Riley | Counselor | 2200 N Patterson St, Valdosta, GA 31602-2597 | 2007-02-23 |
| 1508309030 | Marshall Curtis Harper | Counselor | 2200 N Patterson St, Suite D, Valdosta, GA 31602-2597 | 2016-12-01 |
| 1659814333 | Raven Boyd | Registered Nurse | 2200 N Patterson St, Valdosta, GA 31602-2597 | 2016-11-29 |
| 1629359708 | Lauren Clarke | Counselor | 2200 N Patterson St, Valdosta, GA 31602-2597 | 2011-09-02 |
| 1972737468 | Sandra Gale Wilcher | Social Worker | 2200 N Patterson St, Valdosta, GA 31602-2597 | 2009-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649887431 | Kristi Brynt Godwin | Marriage & Family Therapist | 4457 Kenilworth Cir, Valdosta, GA 31605-8018 | 2020-09-25 |
| 1023638004 | Cartier Owens | Marriage & Family Therapist | 9 Spring Creek Cir, Valdosta, GA 31602-2278 | 2020-04-20 |
| 1720619844 | Michelle Catherine Brooten-brooks | Marriage & Family Therapist | 2704 N Oak St Bldg B3, Valdosta, GA 31602-1797 | 2020-01-28 |
| 1447774195 | Brianna Rae Brown | Marriage & Family Therapist | 907 Pine Cone Cir, Valdosta, GA 31602-1967 | 2017-08-02 |
| 1003261637 | Lynze Vickers, Lmft, LLC | Marriage & Family Therapist | 3350 Noble Way, Suite B, Valdosta, GA 31605-7444 | 2016-05-02 |
| 1669870697 | Lifetime Counseling Service & Management Services | Marriage & Family Therapist | 2905 Bemiss Rd, Valdosta, GA 31602-7007 | 2014-12-08 |
| 1972930105 | Tamika Summers | Marriage & Family Therapist | 3120 N Oak St, Valdosta, GA 31602-1003 | 2013-10-02 |
| 1881035012 | Traci Nacole Ferris | Marriage & Family Therapist | 4133 Springruff Dr, Valdosta, GA 31602-7613 | 2013-07-16 |
| 1336484971 | Molly B Porter | Marriage & Family Therapist | 2908 Fawnwood Cir, Valdosta, GA 31602-4100 | 2012-12-09 |
| 1568707115 | Valerie Smith | Marriage & Family Therapist | 129 Sparrow Hawk Dr, Valdosta, GA 31602-6001 | 2012-12-09 |
| Find all providers in VALDOSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.