Healthcare Provider Details

I. General information

NPI: 1386945327
Provider Name (Legal Business Name): CYNTHIA RENEE BOYLE L.M.H.C., N.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W 4TH ST
WATERLOO IA
50702-2907
US

IV. Provider business mailing address

1409 W 4TH ST
WATERLOO IA
50702-2907
US

V. Phone/Fax

Practice location:
  • Phone: 319-610-4179
  • Fax: 888-853-4291
Mailing address:
  • Phone: 319-610-4179
  • Fax: 888-853-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001289
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019661
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number55918
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10230-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: