Provider Demographics
NPI:1508947433
Name:BOYKAN, MITCH PAUL (MASTER OF COUNSELING)
Entity Type:Individual
Prefix:MR
First Name:MITCH
Middle Name:PAUL
Last Name:BOYKAN
Suffix:
Gender:M
Credentials:MASTER OF COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WEST LANE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051
Mailing Address - Country:US
Mailing Address - Phone:602-973-5906
Mailing Address - Fax:
Practice Address - Street 1:11225 NORTH 28TH DRIVE
Practice Address - Street 2:SUITE D213
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-993-4323
Practice Address - Fax:602-993-0867
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0071101Y00000X
AZLISAC0749101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor