Healthcare Provider Details

I. General information

NPI: 1013362904
Provider Name (Legal Business Name): CLIFFTON BOYKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 YOUREE DR
SHREVEPORT LA
71105-2119
US

IV. Provider business mailing address

410 ROOSEVELT AVE
TERRELL TX
75160-4860
US

V. Phone/Fax

Practice location:
  • Phone: 318-861-8938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010894531
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: