MEDICARE: KETURAH BOYCE

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	101Y00000X	Counselor	113929	TX
2	104100000X	Social Worker	113929	TX
3	1041C0700X	Clinical Social Worker	113929	TX

General Provider Information

NPI Number	:	1508729609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETURAH BOYCE

Provider Business Mailing Address
First Line	:	539 W COMMERCE ST # 1549
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	469-213-0972
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 W COMMERCE ST # 1549
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	469-213-0972
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “ KETURAH BOYCE ” Practice Location

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