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General NPI Number Information
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NPI Number | 1487769725
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Entity Type | Individual
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Provider Name | MICHAEL DOUGLAS BOYD LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6104 AVENUE Q SOUTH DR
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City | LUBBOCK
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State | TX
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Zip | 79412-3700
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Country | US
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Telephone | 806-472-3400
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Fax | 806-472-3421
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Provider Business Mailing Address
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Address Line | 5504 92ND ST
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City | LUBBOCK
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State | TX
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Zip | 79424-4510
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Country | US
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Telephone | 806-794-2104
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34114
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License Number State | TX
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