Kelley Marie Boltin, M.S. LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC 1475 Issued in WY

Practice address

405 W Boxelder Rd Ste C8
Gillette, WY 82718-5320

Phone

(307) 689-4185

Fax

(307) 689-4185

NPI assigned

Jan 25, 2012

Sex

Female

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

State licenses

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1083985733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 S GILLETTE AVE STE 242",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163741",
            "telephone_number": "307-689-9090",
            "fax_number": "307-363-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W BOXELDER RD STE C8",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185320",
            "telephone_number": "307-689-4185",
            "fax_number": "307-689-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTIN",
        "first_name": "KELLEY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.S.  LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-25",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "1475",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "LPC 1475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Gillette, WY
• Providers in Gillette, WY by specialty
• Professional Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.