Provider Demographics
NPI:1124224894
Name:BOYER, SHANNON T (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:T
Last Name:BOYER
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 NE CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2996
Mailing Address - Country:US
Mailing Address - Phone:281-503-7221
Mailing Address - Fax:713-456-2673
Practice Address - Street 1:106 S CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535
Practice Address - Country:US
Practice Address - Phone:281-850-5735
Practice Address - Fax:713-456-2673
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25626103TC0700X, 103TC1900X, 103TH0004X, 103TP2701X, 103TR0400X, 103TA0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)