Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist |
NPI | 1821649419 |
---|---|
Provider Name | Ms. Ashley C Boylan |
First Address | Fort Worth, TX 76119-3554 |
Second Address | Fort Worth, TX 76119-3554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2019 |
Last Update Date | 25/09/2019 |