Provider Demographics
NPI:1396934295
Name:BOYD, NELLIE (LCPC)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9404
Mailing Address - Country:US
Mailing Address - Phone:701-627-4700
Mailing Address - Fax:701-627-4105
Practice Address - Street 1:304 7TH ST N
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-5876
Practice Address - Country:US
Practice Address - Phone:701-627-4700
Practice Address - Fax:701-627-4105
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-178101YM0800X
MTLCPC-1286101YM0800X
MTLMFT-84106H00000X
NDLPC-1045-12-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist