Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 001074 | MO |
NPI | 1003094640 |
---|---|
Provider Name | Mr. Gregory Len Boyt |
First Address | Columbia, MO 65203-4103 |
Second Address | Columbia, MO 65203-4103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 06/02/2008 |