Provider Demographics
NPI:1992434153
Name:BOYCE, JORDAN ELLIS (LCPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELLIS
Last Name:BOYCE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4901
Mailing Address - Country:US
Mailing Address - Phone:734-276-4608
Mailing Address - Fax:
Practice Address - Street 1:40 2ND ST E STE 201
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6112
Practice Address - Country:US
Practice Address - Phone:734-276-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-56137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health