Healthcare Provider Details

I. General information

NPI: 1710537378
Provider Name (Legal Business Name): KIERRA-MAE LARA-BOYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIERRA-MAE BOYKIN LMFT

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PACIFIC BLVD SE STE 101
ALBANY OR
97321-7903
US

IV. Provider business mailing address

1075 WASHINGTON ST
EUGENE OR
97401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-2278
  • Fax:
Mailing address:
  • Phone: 541-321-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2585
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: