Debra L Vandenboom, MAPCC LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401224288 Issued in MI

Practice address

80 Elkenburg St
South Haven, MI 49090-1275

Phone

(269) 205-3502

NPI assigned

Oct 6, 2022

Last updated

Jun 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Debi Vandenboom Other name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• MJR Wellness Counseling, PLLC

  • Adult Mental Health Clinic/Center
  • South Haven, MI
  • NPI 1548936214
  Medicare reassignment NPD
• Tiaraed Warrior LLC

  • Adult Mental Health Clinic/Center
  • Appleton, WI
  • NPI 1871434415
  NPD Authorized official

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

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1043935687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CLEVELAND AVE APT 212",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852364",
            "telephone_number": "262-325-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 ELKENBURG ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901275",
            "telephone_number": "269-205-3502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1850 Colfax Ave",
            "address_purpose": "LOCATION",
            "city": "Benton Harbor",
            "state": "MI",
            "postal_code": "490226753",
            "country_code": "US",
            "telephone_number": "269-926-6199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDENBOOM",
        "first_name": "DEBRA",
        "middle_name": "L",
        "credential": "MAPCC LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-06",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6451020862",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401224288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBI",
            "last_name": "VANDENBOOM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Health Counselor in South Haven, MI
• Providers in South Haven, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.