Provider Demographics
NPI:1780279497
Name:BOYD, REESE (LPC)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 PROVIDENCE CT APT 302
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4036
Mailing Address - Country:US
Mailing Address - Phone:740-296-1889
Mailing Address - Fax:
Practice Address - Street 1:23412 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5813
Practice Address - Country:US
Practice Address - Phone:216-400-6640
Practice Address - Fax:216-250-7016
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002868-TRNE390200000X
OHC.2204603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program