Provider Demographics
NPI:1073962536
Name:LOUIS F. BOYNTON II PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:LOUIS F. BOYNTON II PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FUERTES
Authorized Official - Last Name:BOYNTON
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-525-9830
Mailing Address - Street 1:15 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2022
Mailing Address - Country:US
Mailing Address - Phone:470-215-0167
Mailing Address - Fax:678-525-9830
Practice Address - Street 1:15 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2022
Practice Address - Country:US
Practice Address - Phone:470-215-0167
Practice Address - Fax:678-525-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006747103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty