Healthcare Provider Details

I. General information

NPI: 1467363994
Provider Name (Legal Business Name): EMILY BOVARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 TEAL DR STE 427
EASTON MD
21601-7212
US

IV. Provider business mailing address

8221 TEAL DR STE 427
EASTON MD
21601-7212
US

V. Phone/Fax

Practice location:
  • Phone: 443-602-1269
  • Fax:
Mailing address:
  • Phone: 443-602-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18507
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: