Provider Demographics
NPI:1568455764
Name:BOYD, MISTY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LYNN
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:LYNN
Other - Last Name:ATWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5013
Mailing Address - Country:US
Mailing Address - Phone:918-458-6285
Mailing Address - Fax:918-458-7601
Practice Address - Street 1:1200 W 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5013
Practice Address - Country:US
Practice Address - Phone:918-458-6285
Practice Address - Fax:918-458-7601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical