| Benjamin Daniel Boynton Phd Pllc | |
|
1810 Shiloh Rd Suite 801 Tyler TX 75703-2419 | |
| (903) 593-6355 | |
| Not Available |
| Full Name | Benjamin Daniel Boynton Phd Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1810 Shiloh Rd, Tyler, Texas |
| Authorized Official Name and Position | Benjamin Daniel Boynton (PSYCHOLOGIST) |
| Authorized Official Contact | 9035936355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benjamin Daniel Boynton Phd Pllc 2627 S Broadway Ave Ste 6158 Tyler TX 75701-5405 Ph: (903) 330-6166 | Benjamin Daniel Boynton Phd Pllc 1810 Shiloh Rd Suite 801 Tyler TX 75703-2419 Ph: (903) 593-6355 |
| NPI Number | 1912361841 |
|---|---|
| Provider Enumeration Date | 04/06/2016 |
| Last Update Date | 03/12/2026 |
| Certification Date | 03/12/2026 |
| Medicare PECOS PAC ID | 7810425899 |
|---|---|
| Medicare Enrollment ID | O20250106000980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912361841 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Benjamin Daniel Boynton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508225145 PECOS PAC ID: 4183928963 Enrollment ID: I20160216000267 |
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