Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 25626 | TX |
Y | 103T00000X | Psychologist | 25626 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 25626 | TX |
N | 103G00000X | Clinical Psychologist | 25626 | TX |
N | 103TC0700X | Clinical Psychologist | 25626 | TX |
N | 103TC1900X | Counseling Psychologist | 25626 | TX |
N | 103TH0004X | Health Psychologist | 25626 | TX |
N | 103TP2701X | Group Psychotherapist | 25626 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 25626 | TX |
NPI | 1124224894 |
---|---|
Provider Name | Dr. Shannon T. Boyer |
First Address | Dayton, TX 77535-2996 |
Second Address | Dayton, TX 77535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 13/12/2018 |