Provider Demographics
NPI:1508998469
Name:BOYLE, JOHN JOSEPH
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:BOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:JOSEPH
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:21562 ANNS LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2053
Mailing Address - Country:US
Mailing Address - Phone:714-869-4682
Mailing Address - Fax:
Practice Address - Street 1:462 STEVENS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2075
Practice Address - Country:US
Practice Address - Phone:714-869-4682
Practice Address - Fax:949-460-5322
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist