Provider Demographics
NPI:1871357905
Name:BOYD, NICOLE LYNN (LMSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYNN
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 CLEMENT DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2086
Mailing Address - Country:US
Mailing Address - Phone:989-737-4630
Mailing Address - Fax:
Practice Address - Street 1:4401 CLEMENT DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2086
Practice Address - Country:US
Practice Address - Phone:989-737-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011165811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical