Healthcare Provider Details

I. General information

NPI: 1780457143
Provider Name (Legal Business Name): KIMBERLY BOYKIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 SCOGIN DR STE 160
MONTICELLO AR
71655-5729
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 870-460-4840
  • Fax: 870-460-4845
Mailing address:
  • Phone: 501-812-7215
  • Fax: 501-812-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1403030
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: