Provider Demographics
NPI:1558663302
Name:BOYD, MATTHEW JAMES (LCPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BOYD
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7334 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8352
Mailing Address - Country:US
Mailing Address - Phone:208-250-6906
Mailing Address - Fax:208-936-3836
Practice Address - Street 1:104 9TH AVE S STE B3
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3852
Practice Address - Country:US
Practice Address - Phone:208-495-4263
Practice Address - Fax:208-936-3836
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty