Provider Demographics
NPI:1427262146
Name:BOYD, CHARLES RUSSELL JR (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RUSSELL
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:LPC
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Mailing Address - Street 1:18788 HARVEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARVEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66431-9220
Mailing Address - Country:US
Mailing Address - Phone:785-828-3411
Mailing Address - Fax:785-828-3657
Practice Address - Street 1:21350 W 153RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5413
Practice Address - Country:US
Practice Address - Phone:913-322-2400
Practice Address - Fax:913-621-5730
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSLPC 1855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health