MEDICARE: BOYAN LLC

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	251S00000X	Community/Behavioral Health Agency	00369	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00369	OTHER	GA	LMFT

General Provider Information

NPI Number	:	1669889218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYAN LLC

Provider Business Mailing Address
First Line	:	1936 N DRUID HILLS RD NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4131
Country	:	US
Telephone Number	:	404-273-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 N DRUID HILLS RD NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4131
Country	:	US
Telephone Number	:	404-273-3370
Fax Number	:	404-982-0006

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. SUSAN MARGARET BOYAN
Credential	:	M,ED., LMFT
Telephone Number	:	404-273-3370

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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Directions to “BOYAN LLC ” Practice Location

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