Provider Demographics
NPI:1598060857
Name:BOYD, CHRISTOPHER DANIEL SR (SAC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:BOYD
Suffix:SR
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88385 PIKE RD
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54814-4818
Mailing Address - Country:US
Mailing Address - Phone:715-779-3741
Mailing Address - Fax:715-779-3765
Practice Address - Street 1:37390 N BRADUM RD
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:WI
Practice Address - Zip Code:54814-4832
Practice Address - Country:US
Practice Address - Phone:715-779-3741
Practice Address - Fax:715-779-3765
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15829-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)