Provider Demographics
NPI:1154459899
Name:BOYER, ALYSON RENEE (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:RENEE
Last Name:BOYER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WALKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BIG ROCK
Mailing Address - State:TN
Mailing Address - Zip Code:37023-3022
Mailing Address - Country:US
Mailing Address - Phone:931-232-9993
Mailing Address - Fax:
Practice Address - Street 1:226 WALKER RIDGE RD
Practice Address - Street 2:
Practice Address - City:BIG ROCK
Practice Address - State:TN
Practice Address - Zip Code:37023-3022
Practice Address - Country:US
Practice Address - Phone:931-232-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100287290Medicaid