Provider Demographics
NPI:1710522438
Name:BOYD-MONROE, INDIA (MA)
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:
Last Name:BOYD-MONROE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAINT PIUS CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5433
Mailing Address - Country:US
Mailing Address - Phone:314-283-8876
Mailing Address - Fax:
Practice Address - Street 1:3250 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2379
Practice Address - Country:US
Practice Address - Phone:314-531-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health