Provider Demographics
NPI:1285855965
Name:BOYNE, JOHN DAVID (MA,LPC,SACIT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BOYNE
Suffix:
Gender:M
Credentials:MA,LPC,SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 TOLMAN TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3661
Mailing Address - Country:US
Mailing Address - Phone:608-310-9015
Mailing Address - Fax:
Practice Address - Street 1:1334 APPLEGATE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-3184
Practice Address - Country:US
Practice Address - Phone:608-221-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15064-130101YA0400X
WI3869-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health