Provider Demographics
NPI:1407969975
Name:BOATWRIGHT, MARY LYNN (LPC; LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:LPC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MARKET ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1530
Mailing Address - Country:US
Mailing Address - Phone:409-762-8636
Mailing Address - Fax:409-762-4185
Practice Address - Street 1:2401 TERMINI ST
Practice Address - Street 2:SUITE C
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4995
Practice Address - Country:US
Practice Address - Phone:409-938-4814
Practice Address - Fax:409-938-4849
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004982-041969106H00000X
TX16477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15611020-3Medicaid