Provider Demographics
NPI:1790884203
Name:BOYD, GLENN E (DMIN, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:BOYD
Suffix:
Gender:M
Credentials:DMIN, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 CORPORATE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4096
Mailing Address - Country:US
Mailing Address - Phone:713-642-3377
Mailing Address - Fax:281-494-4307
Practice Address - Street 1:10701 CORPORATE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4096
Practice Address - Country:US
Practice Address - Phone:713-642-3377
Practice Address - Fax:281-494-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10680101YP2500X
TX000207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist