Healthcare Provider Details

I. General information

NPI: 1982636767
Provider Name (Legal Business Name): EDWARD LEE BOYE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIVERSTONE VIS SUITE 201A
BLUE RIDGE GA
30513-6648
US

IV. Provider business mailing address

122 LAKEVIEW PT
TURTLETOWN TN
37391-4818
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-9878
  • Fax:
Mailing address:
  • Phone: 423-496-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number249
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: