Provider Demographics
NPI:1649958406
Name:BOYD, GEORGE WILLIAM IV (LCSW)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:BOYD
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48741
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-0741
Mailing Address - Country:US
Mailing Address - Phone:817-936-3922
Mailing Address - Fax:
Practice Address - Street 1:320 W BEDFORD EULESS RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4011
Practice Address - Country:US
Practice Address - Phone:817-382-2596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical