Charlyn Leslie Raaberg

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4981310-6004 Issued in UT

Practice address

860 E 4500 S Ste 202
Salt Lake City, UT 84107-3014

Phone

(801) 262-9619

NPI assigned

Apr 9, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: darren@blomquisthale.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blomquist Hale Consulting Group

  • Clinical Social Worker
  • Salt Lake City, UT
  • NPI 1609909134

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1225657356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 E 4TH AVE APT 308",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841032489",
            "telephone_number": "801-455-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 E 4500 S STE 202",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841073014",
            "telephone_number": "801-262-9619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAABERG",
        "first_name": "CHARLYN",
        "middle_name": "LESLIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-09",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "4981310-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Darren@blomquisthale.com",
            "affiliation": "Y",
            "endpointDescription": "This is the local Director's business email address where requests can be sent and received.",
            "affiliationName": "Blomquist Hale Consulting Group",
            "address_1": "860 E 4500 S Ste 202",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841073014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daphne Alana Quist, C.S.W.
• James Quist II, LAT, ATC
• R C Halversen MD PC
• R. Duncan Wallace, M.D., P.C.
• R2 Medical
• Hannah Erin Raasch, MD
• Sonja Elizabeth Raaum, MD
• Julianne Rabb, LCSW
• Malcolm Kamai Leano Rabe
• Sandra Rabe

• All providers in Salt Lake City, UT
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.