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General NPI Number Information
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NPI Number | 1073962536
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Entity Type | Organization
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Legal Business Name | LOUIS F. BOYNTON II PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 15 TEMPLE AVE
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City | NEWNAN
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State | GA
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Zip | 30263-2022
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Country | US
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Telephone | 470-215-0167
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Fax | 678-525-9830
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Provider Business Mailing Address
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Address Line | 15 TEMPLE AVE
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City | NEWNAN
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State | GA
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Zip | 30263-2022
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Country | US
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Telephone | 470-215-0167
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Fax | 678-525-9830
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/CEO
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Name | DR. LOUIS FUERTES BOYNTON II
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Credential | PHD
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Telephone | 678-525-9830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LPC006747
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License Number State | GA
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