Active NPI
Bruce Boeck, LCPC
- Professional Counselor
- Normal, IL
National Provider Identifier
1063614600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 1100 Beech St
#10 Normandy Village
Normal, IL 61761-1493 - Phone
- (309) 454-2112
- NPI assigned
- Jun 5, 2007
- Last updated
- Jul 8, 2007
- 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 | IL | Primary |
Addresses
Primary practice location
1100 Beech St
#10 Normandy Village
Normal, IL 61761-1493
Mailing address
207 Suelynn Dr
Normal, IL 61761-1339
Phone (309) 454-1371
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 |
|---|---|---|---|
| 180.003493 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063614600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 SUELYNN DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617611339",
"telephone_number": "309-454-1371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 BEECH ST",
"address_2": "#10 NORMANDY VILLAGE",
"city": "NORMAL",
"state": "IL",
"postal_code": "617611493",
"telephone_number": "309-454-2112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOECK",
"first_name": "BRUCE",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
- Bloomington-Normal Treatment Center, LLC (MedMark Treatment Centers Normal)
- Blue Skies Counseling LLC
- Coreliss Blue, PHARMD
- Karen Marie Blum, LCSW
- Christopher Bobrosky, OT
- Cara Lyn Boester, M.A., CCC-SLP
- Petra Bond, CST
- Laura J Books, ME
- Jeffrey William Bowman, PHARM D
- Linda Sue Bowman, M.S., CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.