Basic Information
| Provider Information | |||||||||
| NPI: | 1801179023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYKO | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 411 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109691914 | ||||||||
| FaxNumber: | 6109693951 | ||||||||
| Practice Location | |||||||||
| Address1: | 1259 S CEDAR CREST BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104025900 | ||||||||
| FaxNumber: | 6104024650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2011 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC005849 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.