Healthcare Provider Details

I. General information

NPI: 1821857608
Provider Name (Legal Business Name): JENNIFER LYNN BOYLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 DE ZAVALA RD
SAN ANTONIO TX
78249-2101
US

IV. Provider business mailing address

6363 DE ZAVALA RD
SAN ANTONIO TX
78249-2101
US

V. Phone/Fax

Practice location:
  • Phone: 210-399-4838
  • Fax:
Mailing address:
  • Phone: 210-399-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105310
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: