Provider Demographics
NPI:1851991053
Name:BOYCE, TIMOTHY SHANE
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SHANE
Last Name:BOYCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4507
Mailing Address - Country:US
Mailing Address - Phone:310-623-1477
Mailing Address - Fax:310-854-0134
Practice Address - Street 1:8739 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4507
Practice Address - Country:US
Practice Address - Phone:310-623-1477
Practice Address - Fax:310-854-0134
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)