Provider Demographics
NPI:1265050116
Name:BOYKINS, JADE MARLI
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:MARLI
Last Name:BOYKINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CLAYS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8411
Mailing Address - Country:US
Mailing Address - Phone:407-417-0800
Mailing Address - Fax:
Practice Address - Street 1:118 CLAYS FERRY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8411
Practice Address - Country:US
Practice Address - Phone:407-417-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2025-03-10
Deactivation Date:2023-02-24
Deactivation Code:
Reactivation Date:2025-03-05
Provider Licenses
StateLicense IDTaxonomies
KY276750101YA0400X
KY295484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)