Anderson Boatman, LPC
Individual provider Active NPI Professional Counselor · Freeport, IL
NPI 1043721665 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1043721665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 178015095 (IL)
- Practice address
- 421 W Exchange St
Freeport, IL 61032-4008 - Phone
- (815) 599-7300
- NPI assigned
- Oct 23, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178015095 | IL | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | 178015095 | IL | Yes |
Addresses
Primary practice location
421 W Exchange St
Freeport, IL 61032-4008
Mailing address
PO Box 813
Freeport, IL 61032-0813
Other providers in Freeport, IL
- Amber Ruth Benson
- Celina Benson
- Joshua Berven
- Gary Alan Besley
- Molly Rose Bilich
- Mishea Tanise Boggess
- Hannah Boldt
- Tamisha Bonvillain
- Kristen Book
- Amanda L Bradbury
All providers in Freeport, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.