Provider Demographics
NPI:1851710453
Name:BOYLE, ELIZABETH LOUISE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:COLLINS.HENRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15607 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-9461
Mailing Address - Country:US
Mailing Address - Phone:334-701-0107
Mailing Address - Fax:
Practice Address - Street 1:15607 STANLEY RD
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-9461
Practice Address - Country:US
Practice Address - Phone:334-701-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS2060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid
MS2060OtherMISS BOARD OF EXAMINERS FOR LPC