Provider Demographics
NPI:1215252689
Name:BOYDSTON, JOSHUA DAVID (MSW, PLCSW)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DAVID
Last Name:BOYDSTON
Suffix:
Gender:M
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1305
Mailing Address - Country:US
Mailing Address - Phone:785-554-8098
Mailing Address - Fax:
Practice Address - Street 1:8150 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5806
Practice Address - Country:US
Practice Address - Phone:816-508-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009375322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children