Basic Information
| Provider Information | |||||||||
| NPI: | 1386618254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYETT | ||||||||
| FirstName: | DONETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 HIGHWAY 9 | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013153344 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 884 W PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PORT TOWNSEND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983682273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603850321 | ||||||||
| FaxNumber: | 3603853944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1443-C | AR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LW61162074 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | SC60910701 | WA | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.