Provider Demographics
NPI:1083213367
Name:BOYD-MCGHEE, GWENDOLYN (LCDC)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:BOYD-MCGHEE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 S CLACK ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1557
Mailing Address - Country:US
Mailing Address - Phone:325-690-5100
Mailing Address - Fax:
Practice Address - Street 1:2626 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1557
Practice Address - Country:US
Practice Address - Phone:325-690-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15047101YA0400X
TX83951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)