Provider Demographics
NPI:1124204086
Name:BOYLAN, COLIN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:BOYLAN
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4209
Mailing Address - Country:US
Mailing Address - Phone:215-605-8231
Mailing Address - Fax:
Practice Address - Street 1:1242 PARK ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5500
Practice Address - Country:US
Practice Address - Phone:510-521-3500
Practice Address - Fax:510-521-8253
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005459101YM0800X
CA2830101YM0800X
CA3802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health