Provider Demographics
NPI:1023634888
Name:BOYDSTUN, DREW
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:BOYDSTUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 S FOX ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-4565
Mailing Address - Country:US
Mailing Address - Phone:303-330-7648
Mailing Address - Fax:
Practice Address - Street 1:5 W DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4427
Practice Address - Country:US
Practice Address - Phone:303-330-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2023-12-19
Deactivation Date:2023-11-14
Deactivation Code:
Reactivation Date:2023-12-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician