Provider Demographics
NPI:1881926772
Name:BOYD-WUERTZ, KAREN M (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:BOYD-WUERTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1882
Mailing Address - Street 2:1515 OLD PONTOTOC ROAD
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856-1882
Mailing Address - Country:US
Mailing Address - Phone:512-293-3927
Mailing Address - Fax:
Practice Address - Street 1:1515 OLD PONTOTOC ROAD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856-1882
Practice Address - Country:US
Practice Address - Phone:512-293-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS810261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health