Provider Demographics
NPI:1710523980
Name:NANCY E BETH BOYETT LICSW LLC
Entity Type:Organization
Organization Name:NANCY E BETH BOYETT LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:251-327-5166
Mailing Address - Street 1:21180 STATE HIGHWAY 181 STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7454
Mailing Address - Country:US
Mailing Address - Phone:251-327-5166
Mailing Address - Fax:251-210-7337
Practice Address - Street 1:21180 STATE HIGHWAY 181 STE 2
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-7454
Practice Address - Country:US
Practice Address - Phone:251-327-5166
Practice Address - Fax:251-210-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty