Beth Ann Boogholt, M.S., BCBA, LLP, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

Phone

(606) 336-3909

Fax

(606) 336-8830

NPI assigned

Dec 3, 2009

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

Credentials

Master of Science

State licenses

Practice roles

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.

• Bluebird Behavioral Services, LLC

  • Behavior Analyst
  • Byron Center, MI
  • NPI 1578167458
  NPD Authorized official
• Endeavor Behavioral Health, LLC

  • Early Intervention Provider Agency
  • Grand Rapids, MI
  • NPI 1306334115
  NPD Authorized official

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

{
    "created_epoch": "1259798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1265760128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "606-336-3909",
            "fax_number": "606-336-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "606-336-3909",
            "fax_number": "606-336-8830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2168 Center Grange Dr",
            "address_purpose": "LOCATION",
            "city": "Byron Center",
            "state": "MI",
            "postal_code": "493159538",
            "country_code": "US",
            "telephone_number": "248-798-0474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "547 Heritage Dr",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "MI",
            "postal_code": "483812735",
            "country_code": "US",
            "telephone_number": "248-798-0474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOGHOLT",
        "first_name": "BETH",
        "middle_name": "ANN",
        "credential": "M.S., BCBA, LLP, LBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-03",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "7401000740",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce W Bonnell, M.D.
• Jesilee Bonofiglio, MSW
• Michael Paul Bonter, PHARMD
• Danielle N Boog, MS, OTR/L
• Jadyn Boogaard
• Booker Behavior Therapy LLC
• Edward A Booker Jr.
• Marilyn Booker, MA, LSC, LLPC
• Lisa Marie Boomers, LLPC
• Sarah Elena Boomgaard-Hughes

• All providers in Grand Rapids, MI
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; 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.