Randall D Boen, MS, CRC, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.011527 Issued in IL

Practice address

204A South St
Anna, IL 62906-1549

Phone

(618) 833-0599

NPI assigned

Jul 22, 2018

Last updated

Jan 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1532217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1073090122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SOUTH ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204A SOUTH ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061549",
            "telephone_number": "618-833-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEN",
        "first_name": "RANDALL",
        "middle_name": "D",
        "credential": "MS, CRC, LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-22",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.011527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Samuel Bass, NP-C
• Nancy L Bass
• Steven M Beatty, M.D.
• Danece Lynn Bennett, APRN
• Tessa Lea Binversie, D.C.
• Russell Gene Boester, D.M.D.
• Richard Bolton
• Kimberly Sue Booker, PT
• Richard D Borders, LCSW
• Nicole Bouiilet

• Mental Health Counselor in Anna, IL
• Providers in Anna, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.