Basic Information
| Provider Information | |||||||||
| NPI: | 1437571460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10401 LINN STATION RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402233842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025898600 | ||||||||
| FaxNumber: | 5024898745 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 HOPKINSVILLE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423451104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703385211 | ||||||||
| FaxNumber: | 2703381624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2014 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 168697 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 7100726490 | 05 | KY | MEDICAID |