Healthcare Provider Details

I. General information

NPI: 1538383229
Provider Name (Legal Business Name): MICHAEL CLYDE BOYLE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 RIDGE RD STE 232
ROCKWALL TX
75087-4250
US

IV. Provider business mailing address

1196 T L TOWNSEND DR APT 217
ROCKWALL TX
75087-0889
US

V. Phone/Fax

Practice location:
  • Phone: 469-769-1744
  • Fax: 469-769-1156
Mailing address:
  • Phone: 469-769-1744
  • Fax: 281-419-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18737
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: