Provider Demographics
NPI:1831611763
Name:BOICE, PAUL CANOVA (MFTI)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CANOVA
Last Name:BOICE
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 FREEBOARD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5039
Mailing Address - Country:US
Mailing Address - Phone:530-351-7975
Mailing Address - Fax:
Practice Address - Street 1:3120 FREEBOARD DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-351-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health