Active NPI
Suresh E Bolem, LPC
- Professional Counselor
- Little Elm, TX
National Provider Identifier
1003523531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 79033
- Practice address
- 2640 Redcedar Dr
Little Elm, TX 75068-6604 - Phone
- (972) 375-6843
- NPI assigned
- Nov 3, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 79033 | TX | Primary |
Addresses
Primary practice location
2640 Redcedar Dr
Little Elm, TX 75068-6604
Mailing address
2640 Redcedar Dr
Little Elm, TX 75068-6604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79033 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667433600000",
"number": "1003523531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2640 REDCEDAR DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750686604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2640 REDCEDAR DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750686604",
"telephone_number": "972-375-6843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLEM",
"first_name": "SURESH",
"middle_name": "E",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-03",
"last_updated": "2022-11-03",
"certification_date": "2022-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "79033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Elm, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.