Provider Demographics
NPI:1619017209
Name:BOYD, SUSAN (MS, MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4402
Mailing Address - Country:US
Mailing Address - Phone:661-397-8323
Mailing Address - Fax:
Practice Address - Street 1:9711 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2772
Practice Address - Country:US
Practice Address - Phone:661-322-1020
Practice Address - Fax:661-322-0552
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32534106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51124ZOtherBLUE SHIELD