Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 16967 | TX |
Y | 101YP2500X | Professional Counselor | 16967 | TX |
NPI | 1992978472 |
---|---|
Provider Name | Ms. Dana Boyles |
First Address | San Antonio, TX 78201-5159 |
Second Address | San Antonio, TX 78201-5159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 07/04/2008 |