Provider Demographics
NPI:1477993335
Name:BOYD, HEATHER (IMF #75174)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:IMF #75174
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1399
Mailing Address - Country:US
Mailing Address - Phone:805-884-1669
Mailing Address - Fax:
Practice Address - Street 1:429 N SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1399
Practice Address - Country:US
Practice Address - Phone:805-884-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113040106H00000X
CAIMF #75174171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist