Provider Demographics
NPI:1275073041
Name:BOYD, DAVE (MFTA)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 28TH CT NE STE A
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-7161
Mailing Address - Country:US
Mailing Address - Phone:360-742-0418
Mailing Address - Fax:360-890-4099
Practice Address - Street 1:8284 28TH CT NE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-7161
Practice Address - Country:US
Practice Address - Phone:360-742-0418
Practice Address - Fax:360-890-4099
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60797974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist