Jeremy Craig Bolden, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SC60970302 Issued in WA

Practice address

4804 Lacey Blvd SE Ste a
Lacey, WA 98503-5733

Phone

(360) 799-5782

NPI assigned

Jun 20, 2019

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Pathways Mental Health ServicesGroup PAC ID 5496053803, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Pathways Mental Health Services

  • Mental Health Counselor
  • Olympia, WA
  • NPI 1306004775
  Medicare reassignment Care Compare group NPD
• Elaine Vaughn Counseling LLC

  • Mental Health Counselor
  • Lacey, WA
  • NPI 1780403097
  Medicare reassignment NPD

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1649830647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6049 MERLOT LN SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985132243",
            "telephone_number": "253-335-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4804 LACEY BLVD SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035733",
            "telephone_number": "360-799-5782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDEN",
        "first_name": "JEREMY",
        "middle_name": "CRAIG",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-20",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC60970302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly M Blue, LMFTA
• Aaron David Blume
• Sophia Marie Blume
• Body Essentials, LLC
• Bodywork and Massage Center
• Whitney Michelle Boling, LMP
• Bonaventure of Lacey
• Carlos Bonilla
• Julieta Quia Bonilla, RN
• Erica Bonte

• Clinical Social Worker in Lacey, WA
• Providers in Lacey, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.