Provider Demographics
NPI:1376827915
Name:HORTON, BOYD RANDAL (PSY D, HSPP)
Entity Type:Individual
Prefix:MR
First Name:BOYD
Middle Name:RANDAL
Last Name:HORTON
Suffix:
Gender:M
Credentials:PSY D, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8946 FOREST WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-8903
Mailing Address - Country:US
Mailing Address - Phone:317-374-5183
Mailing Address - Fax:
Practice Address - Street 1:1800 N MERIDIAN ST STE 202
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1443
Practice Address - Country:US
Practice Address - Phone:317-981-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TM1800X, 251S00000X
IN20041741A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health