Provider Demographics
NPI:1992990147
Name:BOYD, JENINE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENINE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP SOUTH
Mailing Address - Street 2:#390
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2900
Mailing Address - Country:US
Mailing Address - Phone:281-543-9167
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S STE 390
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2917
Practice Address - Country:US
Practice Address - Phone:281-543-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical