Healthcare Provider Details

I. General information

NPI: 1649513862
Provider Name (Legal Business Name): JOHN WATSON BOYD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 SE LICYNTRA LN
MILWAUKIE OR
97222-6058
US

IV. Provider business mailing address

3889 SE LICYNTRA LN
MILWAUKIE OR
97222-6058
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-1331
  • Fax:
Mailing address:
  • Phone: 503-653-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1357
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: