Provider Demographics
NPI:1205256864
Name:BOYD, SCOTT MATTHEW (LPC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MATTHEW
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 1:3302 STOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2731
Mailing Address - Country:US
Mailing Address - Phone:814-881-8791
Mailing Address - Fax:
Practice Address - Street 1:3302 STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2731
Practice Address - Country:US
Practice Address - Phone:814-881-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional