Provider Demographics
NPI:1417158841
Name:BOYD, BOBBIE SUE (LPE)
Entity Type:Individual
Prefix:DR
First Name:BOBBIE
Middle Name:SUE
Last Name:BOYD
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21219
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-1219
Mailing Address - Country:US
Mailing Address - Phone:501-224-7626
Mailing Address - Fax:501-224-5048
Practice Address - Street 1:4 SHACKLEFORD PLZ
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1826
Practice Address - Country:US
Practice Address - Phone:501-224-7626
Practice Address - Fax:501-224-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR79-33E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health