Active NPI
Regina Bomar
- Professional Counselor
- Southfield, MI
National Provider Identifier
1053509141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401007471
- Practice address
- 23640 Oak Glen Dr
Southfield, MI 48033-3497 - Phone
- (248) 479-1007
- NPI assigned
- Oct 15, 2007
- Last updated
- Oct 15, 2007
- Sex
- Female
- 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 | 6401007471 | MI | Primary |
Addresses
Primary practice location
23640 Oak Glen Dr
Southfield, MI 48033-3497
Mailing address
23640 Oak Glen Dr
Southfield, MI 48033-3497
Phone (248) 479-1007
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401007471 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192406400000",
"number": "1053509141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23640 OAK GLEN DR",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333497",
"telephone_number": "248-479-1007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23640 OAK GLEN DR",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333497",
"telephone_number": "248-479-1007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOMAR",
"first_name": "REGINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-15",
"last_updated": "2007-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401007471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.