Provider Demographics
NPI:1427431766
Name:BOYD, TINA L
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:L
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA, SWA
Mailing Address - Street 1:809 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1054
Mailing Address - Country:US
Mailing Address - Phone:419-335-5533
Mailing Address - Fax:
Practice Address - Street 1:809 W VINE ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1054
Practice Address - Country:US
Practice Address - Phone:419-222-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH080722101YA0400X
OHW.0900007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist