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General NPI Number Information
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NPI Number | 1144355041
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Entity Type | Individual
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Provider Name | DAVID MICHAEL BOARMAN MSC LPC LISAC
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 11022 S 51ST ST STE 100 AHWATUKEE EXECUTIVE PLAZA
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City | PHOENIX
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State | AZ
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Zip | 85044
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Country | US
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Telephone | 602-284-4976
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Fax | 480-753-0060
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Provider Business Mailing Address
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Address Line | 15257 S 22ND ST
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-759-3792
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Fax | 480-753-0060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC 0217
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 0727
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License Number State | AZ
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