Healthcare Provider Details

I. General information

NPI: 1255810388
Provider Name (Legal Business Name): DAMION L BOYD SR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S WASHINGTON ST
VAN WERT OH
45891-1707
US

IV. Provider business mailing address

123 S WASHINGTON ST
VAN WERT OH
45891-1707
US

V. Phone/Fax

Practice location:
  • Phone: 419-771-1050
  • Fax: 419-771-1051
Mailing address:
  • Phone: 419-771-1050
  • Fax: 419-771-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2304928
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: