=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447371059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH M BOYD LMFC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5148 FREDERICKSBURG WY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-300-6859
-----------------------------------------------------
Fax | 916-561-6701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5148 FREDERICKSBURG WY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-300-6859
-----------------------------------------------------
Fax | 916-561-6701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT 30569
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------