Provider Demographics
NPI:1508225145
Name:BOYNTON, BENJAMIN DANIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:BOYNTON
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 S BROADWAY AVE STE 6158
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5405
Mailing Address - Country:US
Mailing Address - Phone:903-330-6166
Mailing Address - Fax:903-534-6518
Practice Address - Street 1:1810 SHILOH RD STE 801
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2457
Practice Address - Country:US
Practice Address - Phone:903-593-6355
Practice Address - Fax:903-534-6518
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34827103G00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent