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NPI Code Detail

MEDICARE: MRS. DONETTE BOYETT LCSW-A

MEDICARE: MRS. DONETTE BOYETT LCSW-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1443-CAR
21041C0700XClinical Social WorkerLW61162074WA
3101Y00000XCounselorSC60910701WA

General Provider Information

NPI Number : 1386618254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONETTE BOYETT LCSW-A
Provider Business Mailing Address
First Line : 105 HIGHWAY 9
Second Line :
City : OXFORD
State : AR
Zip : 72565
Country : US
Telephone Number : 501-315-3344
Fax Number :
Provider Business Practice Location Address
First Line : 884 W PARK AVE
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2273
Country : US
Telephone Number : 360-385-0321
Fax Number : 360-385-3944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 06/11/2021

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