Healthcare Provider Details

I. General information

NPI: 1871155101
Provider Name (Legal Business Name): MICHAEL C BOYLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 RIDGE RD STE 232
ROCKWALL TX
75087-4250
US

IV. Provider business mailing address

918 MANGROVE DR
FATE TX
75087-6917
US

V. Phone/Fax

Practice location:
  • Phone: 469-769-1744
  • Fax:
Mailing address:
  • Phone: 469-769-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL C BOYLE
Title or Position: PHD
Credential: OWNER
Phone: 469-769-1744