Sandra Sue Dale Boulware, LPC, MAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

440 Issued in OK

Practice address

1121 K St NW
Miami, OK 74354-2915

Phone

(918) 542-5671

NPI assigned

May 1, 2009

Last updated

May 1, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

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": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241136000000",
    "number": "1235373465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 K ST NW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743542915",
            "telephone_number": "918-542-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 K ST NW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743542915",
            "telephone_number": "918-542-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULWARE",
        "first_name": "SANDRA",
        "middle_name": "SUE DALE",
        "name_prefix": "Ms.",
        "credential": "LPC, MAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-01",
        "last_updated": "2009-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OK",
            "license": "440",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "15991",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "440",
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "OK",
            "license": "109413",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jana Michelle Blevins, MS CCC-SLP
• Nicole Blodgett
• Kelly Ann Bokay, LPC
• Christina Lynn Bond, PRSS
• Audrey Danielle Bosworth, APRN
• Tori Boyd, PTA
• Bradford Jay Stephens MD PC
• Randall Watson Brady, CRNA
• Brady's Home Health Care,Inc
• Jason Edward Brandon, MS

• Professional Counselor in Miami, OK
• Providers in Miami, OK by specialty
• Professional Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; 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.