Basic Information
| Provider Information | |||||||||
| NPI: | 1568635654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13684 TRUCHARD ST | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836076701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083669476 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13684 TRUCHARD ST | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836076701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083669476 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2008 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | RC00055771 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 7484 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.