Provider Demographics
NPI:1649513862
Name:BOYD, JOHN WATSON (LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WATSON
Last Name:BOYD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 SE LICYNTRA LN
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6058
Mailing Address - Country:US
Mailing Address - Phone:503-653-1331
Mailing Address - Fax:
Practice Address - Street 1:3889 SE LICYNTRA LN
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6058
Practice Address - Country:US
Practice Address - Phone:503-653-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional