Provider Demographics
NPI:1912361841
Name:BENJAMIN DANIEL BOYNTON PHD PLLC
Entity Type:Organization
Organization Name:BENJAMIN DANIEL BOYNTON PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYNTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-330-6166
Mailing Address - Street 1:2512 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6410
Mailing Address - Country:US
Mailing Address - Phone:903-330-6166
Mailing Address - Fax:
Practice Address - Street 1:1810 SHILOH RD
Practice Address - Street 2:SUITE 801
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2419
Practice Address - Country:US
Practice Address - Phone:903-593-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34827251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health