Provider Demographics
NPI:1780046300
Name:BOYNTON, LOUIS FUERTES II (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:FUERTES
Last Name:BOYNTON
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:FUERTES
Other - Last Name:BOYNTON
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:15 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2022
Mailing Address - Country:US
Mailing Address - Phone:678-525-9830
Mailing Address - Fax:
Practice Address - Street 1:15 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2022
Practice Address - Country:US
Practice Address - Phone:678-525-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006747103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling