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General NPI Number Information
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NPI Number | 1417106717
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Entity Type | Individual
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Provider Name | JOHANNA NICOLE BOYD M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 102 23RD AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-4501
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Country | US
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Telephone | 253-365-7290
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Fax | 253-987-7223
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Provider Business Mailing Address
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Address Line | 4227 S MERIDIAN STE C223
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City | PUYALLUP
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State | WA
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Zip | 98373-3603
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Country | US
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Telephone | 253-365-7290
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Fax | 253-987-7223
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MG60117140
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60247677
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License Number State | WA
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