Provider Demographics
NPI:1083270219
Name:BOYD, ANDREW CLARK (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CLARK
Last Name:BOYD
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 LUTHER FOWLER RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8399
Mailing Address - Country:US
Mailing Address - Phone:850-602-3533
Mailing Address - Fax:
Practice Address - Street 1:3819 LUTHER FOWLER RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8399
Practice Address - Country:US
Practice Address - Phone:850-602-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health