1508947433 NPI number — MR. MITCH PAUL BOYKAN MASTER OF COUNSELING

Table of content: MR. MITCH PAUL BOYKAN MASTER OF COUNSELING (NPI 1508947433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508947433 NPI number — MR. MITCH PAUL BOYKAN MASTER OF COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYKAN
Provider First Name:
MITCH
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MASTER OF COUNSELING
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508947433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 WEST LANE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-973-5906
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11225 NORTH 28TH DRIVE
Provider Second Line Business Practice Location Address:
SUITE D213
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-993-4323
Provider Business Practice Location Address Fax Number:
602-993-0867
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC0071 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: LISAC0749 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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