Provider Demographics
NPI:1619208840
Name:BOYCE, MARY JENNIFER (MA, LPC, LAT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JENNIFER
Last Name:BOYCE
Suffix:
Gender:F
Credentials:MA, LPC, LAT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8514 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1140
Mailing Address - Country:US
Mailing Address - Phone:503-984-7343
Mailing Address - Fax:844-803-3556
Practice Address - Street 1:8514 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1140
Practice Address - Country:US
Practice Address - Phone:503-984-7343
Practice Address - Fax:844-803-3556
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC3694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health