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General NPI Number Information
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NPI Number | 1508225145
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Entity Type | Individual
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Provider Name | BENJAMIN DANIEL BOYNTON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1810 SHILOH RD STE 801
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City | TYLER
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State | TX
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Zip | 75703-2457
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Country | US
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Telephone | 903-593-6355
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Fax | 903-534-6518
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Provider Business Mailing Address
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Address Line | 2627 S BROADWAY AVE STE 6158
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City | TYLER
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State | TX
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Zip | 75701-5405
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Country | US
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Telephone | 903-330-6166
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Fax | 903-534-6518
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 34827
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 34827
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34827
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License Number State | TX
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