Provider Demographics
NPI:1053979518
Name:BOYD, MEGAN LYNNE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNNE
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 JOURNEY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9351
Mailing Address - Country:US
Mailing Address - Phone:925-313-0876
Mailing Address - Fax:
Practice Address - Street 1:3181 JOURNEY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-9351
Practice Address - Country:US
Practice Address - Phone:925-313-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124134106H00000X
CA103475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist