Mallory Boich, MS, LCPC

Key facts

NPI

1477097772

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

Practice address

2725 Jackrabbit LN Ste 3
Bozeman, MT 59718-5717

Phone

(847) 903-5123

NPI assigned

Dec 6, 2016

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 4, 2018.

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1477097772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 JACKRABBIT LN STE 3",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597185717",
            "telephone_number": "847-903-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 JACKRABBIT LN STE 3",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597185717",
            "telephone_number": "847-903-5123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1970 Stadium Dr",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597150623",
            "country_code": "US",
            "telephone_number": "847-903-5123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOICH",
        "first_name": "MALLORY",
        "credential": "MS, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-06",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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