Individual
MRS. TINA MARIE OTTMAN-BOYKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSE LCSW LPC NCC
Contact information
Practice address
2209 EASTERN AVE, PLYMOUTH, WI 53073-4281
(920) 892-7606
Mailing address
2209 EASTERN AVE, PLYMOUTH, WI 53073-4281
(920) 892-7606
(920) 892-7606
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1568125
WI
1041C0700X
Clinical Social Worker
Primary
2886123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138002
CHAMPUS TRICARE
—
05
—
39744000
—
WI
Enumeration date
08/17/2006
Last updated
05/09/2023
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