Paul R Boothroyd Jr., LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401013357 Issued in MI

Practice address

5100 Eastman Ave
Suite 2
Midland, MI 48640

Phone

(989) 832-0191

Fax

(989) 486-9413

NPI assigned

Dec 22, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 17, 2024 through Jan 17, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Still Water Professional Counseling, LLC

  • Professional Counselor
  • Midland, MI
  • NPI 1609381631
  NPD Authorized official

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

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1538524244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 EASTMAN AVE",
            "address_2": "SUITE 2",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-832-0191",
            "fax_number": "989-486-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 EASTMAN AVE",
            "address_2": "SUITE 2",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-832-0191",
            "fax_number": "989-486-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTHROYD",
        "first_name": "PAUL",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-22",
        "last_updated": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shay Bonham
• Blake Bonkowski, PHARMD
• Rebecca Ann Boos
• Stephanie Booth
• Carol Lindley Boothroyd, LLPC
• Valerie Born
• Samantha Borowiak
• David T. Bortel, M.D.
• Kirk J Bortel, M.D.
• Boss and Rorvik Family Dental, PLLC

• Professional Counselor in Midland, MI
• Providers in Midland, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.