Provider Demographics
NPI:1538383229
Name:BOYLE, MICHAEL CLYDE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLYDE
Last Name:BOYLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 T L TOWNSEND DR APT 217
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0889
Mailing Address - Country:US
Mailing Address - Phone:469-769-1744
Mailing Address - Fax:281-419-1811
Practice Address - Street 1:1101 RIDGE RD STE 232
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4250
Practice Address - Country:US
Practice Address - Phone:469-769-1744
Practice Address - Fax:469-769-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388527901Medicaid