Daniel P. Boehmer, LCPC
Individual provider Active NPI Professional Counselor · Mount Vernon, IL
NPI 1447724737 · NPPES record last updated Jan 20, 2019
Key facts
- NPI
- 1447724737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180.004913 (IL)
- Practice address
- 107 Shiloh Dr
Mount Vernon, IL 62864-7301 - Phone
- (618) 242-6944
- Fax
- (618) 242-6726
- NPI assigned
- Jan 20, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.004913 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spero Family Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.004913 | IL | Yes |
Addresses
Primary practice location
107 Shiloh Dr
Mount Vernon, IL 62864-7301
Mailing address
14687 N Lost Lake LN
Mount Vernon, IL 62864-8097
Phone (618) 214-5463
Other providers in Mount Vernon, IL
- William Alan Bishop
- Eric Lee Black
- Clarisa Blakemore
- Helaine Sue Blomenkamp
- Katherine Bloodworth
- Curtis William Boehne
- Olivia Boehnke
- Michele L Boester
- Brittney Boldt
- Faye Boldwyn-Stephens
All providers in Mount Vernon, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.