Basic Information
| Provider Information | |||||||||
| NPI: | 1952643801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYLES | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1413 S PATRICK DR | ||||||||
| Address2: | STE 4 | ||||||||
| City: | SATELLITE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329374344 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1413 S PATRICK DR | ||||||||
| Address2: | STE 4 | ||||||||
| City: | SATELLITE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329374344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217225200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW10918 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.