Provider Demographics
NPI:1952894941
Name:BOYD, KRISTIN MARILYN WHITED (TCADC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARILYN WHITED
Last Name:BOYD
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 5TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6272
Mailing Address - Country:US
Mailing Address - Phone:515-233-1699
Mailing Address - Fax:
Practice Address - Street 1:208 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6272
Practice Address - Country:US
Practice Address - Phone:515-233-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)