Provider Demographics
NPI:1154452514
Name:BOYD, MARTHA JOLENE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JOLENE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1510
Mailing Address - Country:US
Mailing Address - Phone:816-445-4285
Mailing Address - Fax:
Practice Address - Street 1:620 E 18TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1510
Practice Address - Country:US
Practice Address - Phone:816-445-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002006846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002006846OtherLICENSED PROF. COUNSELOR