Provider Demographics
NPI:1659085959
Name:BOYD, KATINKA (TLPC)
Entity Type:Individual
Prefix:
First Name:KATINKA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:TLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 FORT SUMTER DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-9457
Mailing Address - Country:US
Mailing Address - Phone:423-763-8778
Mailing Address - Fax:
Practice Address - Street 1:2417 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6226
Practice Address - Country:US
Practice Address - Phone:423-205-1218
Practice Address - Fax:844-206-1291
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health