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General NPI Number Information
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NPI Number | 1881926772
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Entity Type | Individual
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Provider Name | KAREN M. BOYD-WUERTZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 1515 OLD PONTOTOC ROAD
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City | MASON
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State | TX
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Zip | 76856-1882
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Country | US
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Telephone | 512-293-3927
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1882 1515 OLD PONTOTOC ROAD
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City | MASON
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State | TX
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Zip | 76856-1882
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Country | US
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Telephone | 512-293-3927
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 810
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License Number State | KS
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