Healthcare Provider Details

I. General information

NPI: 1992271407
Provider Name (Legal Business Name): DANIELLE BOYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W WASHINGTON CENTER RD
FORT WAYNE IN
46825-4142
US

IV. Provider business mailing address

1313 W WASHINGTON CENTER RD
FORT WAYNE IN
46825-4142
US

V. Phone/Fax

Practice location:
  • Phone: 260-424-4908
  • Fax: 260-264-4146
Mailing address:
  • Phone: 260-424-4908
  • Fax: 260-264-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number99136515A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99129680A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: