Healthcare Provider Details

I. General information

NPI: 1477993335
Provider Name (Legal Business Name): HEATHER BOYD IMF #75174
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1399
US

IV. Provider business mailing address

429 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1399
US

V. Phone/Fax

Practice location:
  • Phone: 805-884-1669
  • Fax:
Mailing address:
  • Phone: 805-884-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113040
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberIMF #75174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: