Randall D Boen, MS, CRC, LCPC
Individual provider Active NPI Mental Health Counselor · Anna, IL
NPI 1073090122 · NPPES record last updated Jan 31, 2023
Key facts
- NPI
- 1073090122
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 180.011527 (IL)
- Practice address
- 204A South St
Anna, IL 62906-1549 - Phone
- (618) 833-0599
- NPI assigned
- Jul 22, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.011527 | IL | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Counselor | 225C00000X | |||
| Mental Health Counselor | 101YM0800X | 180.011527 | IL | Yes |
Addresses
Primary practice location
204A South St
Anna, IL 62906-1549
Mailing address
204 South St
Anna, IL 62906-1549
Other providers in Anna, IL
- Keith Samuel Bass
- Nancy L Bass
- Steven M Beatty
- Danece Lynn Bennett
- Tessa Lea Binversie
- Russell Gene Boester
- Richard Bolton
- Kimberly Sue Booker
- Nicole Bouiilet
- Leeann Brandt
All providers in Anna, IL · Mental Health 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 Jan 31, 2023. 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.