Provider Demographics
NPI:1770096018
Name:KATIE BOYD, PSY.D., LLC
Entity type:Organization
Organization Name:KATIE BOYD, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:314-833-8833
Mailing Address - Street 1:10411 CLAYTON RD STE 209
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2912
Mailing Address - Country:US
Mailing Address - Phone:314-833-8833
Mailing Address - Fax:
Practice Address - Street 1:10411 CLAYTON RD STE 209
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2912
Practice Address - Country:US
Practice Address - Phone:314-833-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010036595103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1659671832OtherINDIVIDUAL NPI