Provider Demographics
NPI:1144230871
Name:BOYCE, BONNIE SUE (LMFT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:SUE
Other - Last Name:WOODGEARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:505 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3219
Mailing Address - Country:US
Mailing Address - Phone:815-519-0257
Mailing Address - Fax:304-528-7848
Practice Address - Street 1:505 12TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3219
Practice Address - Country:US
Practice Address - Phone:815-519-0257
Practice Address - Fax:304-529-7848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000451106H00000X
WV1 PROVISIONAL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist