Provider Demographics
NPI:1417013269
Name:BOYD, GRETCHEN HERZBURG
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:HERZBURG
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-1033
Mailing Address - Country:US
Mailing Address - Phone:517-486-2137
Mailing Address - Fax:517-486-2137
Practice Address - Street 1:115 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1033
Practice Address - Country:US
Practice Address - Phone:517-486-2137
Practice Address - Fax:517-486-2137
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000321101YP2500X
MI4101005577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist