=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790884203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN E BOYD D.MIN., LPC, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10701 CORPORATE DR SUITE 220
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-4096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-642-3377
-----------------------------------------------------
Fax | 281-494-4307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10701 CORPORATE DR SUITE 220
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-4096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-642-3377
-----------------------------------------------------
Fax | 281-494-4307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 10680
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000207
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------