Healthcare Provider Details

I. General information

NPI: 1588568257
Provider Name (Legal Business Name): DEMARKUS BURROUGHS BOYKIN SR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 MORGAN AVE
MOBILE AL
36606-1532
US

IV. Provider business mailing address

612 MORGAN AVE
MOBILE AL
36606-1532
US

V. Phone/Fax

Practice location:
  • Phone: 817-482-0537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number102227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: