Basic Information
| Provider Information | |||||||||
| NPI: | 1992331722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYCE | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7232 JUSTIN WAY | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440604881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405788200 | ||||||||
| FaxNumber: | 4405341985 | ||||||||
| Practice Location | |||||||||
| Address1: | 21100 SOUTHGATE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | MAPLE HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441373004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405788200 | ||||||||
| FaxNumber: | 4405341985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2020 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.1902040-TRNE | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.