Katelyn Boles, LPC

Key facts

NPI

1265980593

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

License

P1904050 (AR)

Practice address

206 Levesque Ave E
Wynne, AR 72396-2938

Phone

(870) 351-0312

NPI assigned

Sep 15, 2016

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Changes Behavioral Health, LLC Community/Behavioral Health Agency · Wynne, AR · NPI 1114260486
  Medicare reassignment NPD AR

Medicare participation

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 21, 2024.

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1265980593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 COUNTY ROAD 367",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723968079",
            "telephone_number": "703-510-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 LEVESQUE AVE E",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723962938",
            "telephone_number": "870-351-0312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1825 E Broadway St",
            "address_purpose": "LOCATION",
            "city": "Forrest City",
            "state": "AR",
            "postal_code": "723353409",
            "country_code": "US",
            "telephone_number": "870-630-2328",
            "fax_number": "870-630-2348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLES",
        "first_name": "KATELYN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-15",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A1609114",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P1904050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Pleasants Bradshaw, M.D.

All providers in Wynne, AR · Mental Health Counselor in Arkansas