Healthcare Provider Details

I. General information

NPI: 1215252689
Provider Name (Legal Business Name): JOSHUA DAVID BOYDSTON MSW, PLCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 WORNALL RD
KANSAS CITY MO
64114-5806
US

IV. Provider business mailing address

4400 W 51ST ST
ROELAND PARK KS
66205-1305
US

V. Phone/Fax

Practice location:
  • Phone: 816-508-3517
  • Fax:
Mailing address:
  • Phone: 785-554-8098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number2010009375
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: