MEDICARE: NELLIE BOYD LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-178	SD
2	101YM0800X	Mental Health Counselor	LCPC-1286	MT
3	106H00000X	Marriage & Family Therapist	LMFT-84	MT
4	101YM0800X	Mental Health Counselor	LPC-1045-12-1	ND

General Provider Information

NPI Number	:	1396934295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLIE BOYD LCPC

Provider Business Mailing Address
First Line	:	404 FRONTAGE RD
Second Line	:
City	:	NEW TOWN
State	:	ND
Zip	:	58763-9404
Country	:	US
Telephone Number	:	701-627-4700
Fax Number	:	701-627-4105

Provider Business Practice Location Address
First Line	:	304 7TH ST N
Second Line	:
City	:	NEW TOWN
State	:	ND
Zip	:	58763-5876
Country	:	US
Telephone Number	:	701-627-4700
Fax Number	:	701-627-4105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	02/24/2022

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