Healthcare Provider Details

I. General information

NPI: 1952583155
Provider Name (Legal Business Name): ANA M BOYDSTUN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S K ST
TULARE CA
93274-5416
US

IV. Provider business mailing address

327 S K ST
TULARE CA
93274-5416
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2043
  • Fax: 559-688-1304
Mailing address:
  • Phone: 559-688-2043
  • Fax: 559-688-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: