Larry W Boomgaarden, B.A., LAC-T

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1000 8TH St SE
Detroit Lakes, MN 56501-2819

Phone

(218) 847-0696

Fax

(218) 847-4198

NPI assigned

Jul 8, 2009

Sex

Male

Sole proprietor

No

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.

• Jesola Inc

  • Addiction (Substance Use Disorder) Counselor
  • Detroit Lakes, MN
  • NPI 1861497190

  Addiction (Substance Use Disorder)

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 2, 2018.

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1295964518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 8TH ST SE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012819",
            "telephone_number": "218-847-0696",
            "fax_number": "218-847-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 8TH ST SE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012819",
            "telephone_number": "218-847-0696",
            "fax_number": "218-847-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMGAARDEN",
        "first_name": "LARRY",
        "middle_name": "W",
        "credential": "B.A., LAC-T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anika Bohmer
• Juldie Lynn Bohmer, LPCC
• Melissa Boit
• Randall J. Bolar, M.D.
• Sharon Lynn Bolar, PA-C
• Lola Marie Booth, LADC
• Kari Jo Borgmann, PT
• Riley Bourdon
• Madison Bowers, PT
• Gary L. Bowman, PH.D.

• All providers in Detroit Lakes, MN
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; 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.