Trebor Wellington Bosley, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2010088 Issued in AR

Practice address

1815 Pleasant Grove Rd
Jonesboro, AR 72405-7870

Phone

(870) 933-6886

Fax

(870) 933-9395

NPI assigned

Feb 22, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Trebor Wellington Bosley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Families, Inc of Arkansas

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jonesboro, AR
  • NPI 1770535569
  NPD
• Oaktree Counseling Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norman, OK
  • NPI 1114188331
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1003138710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724057870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724057870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSLEY",
        "first_name": "TREBOR",
        "middle_name": "WELLINGTON",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-22",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2010088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101YM0800X",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TREBOR",
            "last_name": "BOSLEY",
            "middle_name": "WELLINGTON",
            "credential": "MHR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Distretti Boozer, MPT
• James Robert Boozer
• Quenna Faye Borders, MHPP
• Quiera Borders
• Elizabeth Boren, PT
• Kenneth Bounds
• Niels M Bouse
• Carlissa May Bowen, LPC
• Chasity Ann Bowen, MHPP
• Hannah Bowen, RBT

• Professional Counselor in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.