Provider Demographics
NPI:1487299103
Name:BETH BOATMAN, LPC-S
Entity type:Organization
Organization Name:BETH BOATMAN, LPC-S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S, PLLC
Authorized Official - Phone:770-265-1007
Mailing Address - Street 1:5805 BRYTON CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1209
Mailing Address - Country:US
Mailing Address - Phone:770-265-1007
Mailing Address - Fax:706-413-1377
Practice Address - Street 1:211 E SOUTHLAKE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6274
Practice Address - Country:US
Practice Address - Phone:770-265-1007
Practice Address - Fax:706-413-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty