MEDICARE: CHERYL BOYLAND LPC-S, NCC

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	63738	TX
2	101YM0800X	Mental Health Counselor	63738	TX
3	101YP2500X	Professional Counselor	63738	TX

General Provider Information

NPI Number	:	1750635421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL BOYLAND LPC-S, NCC

Provider Business Mailing Address
First Line	:	4101 W GREEN OAKS BLVD
Second Line	:	SUITE 305-162
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4462
Country	:	US
Telephone Number	:	817-412-9397
Fax Number	:	817-394-1909

Provider Business Practice Location Address
First Line	:	4101 W GREEN OAKS BLVD
Second Line	:	SUITE 305-162
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4462
Country	:	US
Telephone Number	:	817-412-9397
Fax Number	:	817-394-1909

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

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	11/02/2012

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