Lara Skye Boughman, LPC, CSAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5352-125 Issued in WI

Practice address

4785 Hayes Rd Ste 200
Madison, WI 53704-7364

Phone

(608) 844-8473

Fax

(608) 400-8422

NPI assigned

May 22, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WI

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

Mental Health Counselor

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  WI

  Medicare reassignment
• Caya Clinic, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
  • NPI 1619758356
  NPD (past)
• Open Door Center for Change LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
  • NPI 1215068069
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1689884686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4785 HAYES RD STE 200",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537047364",
            "telephone_number": "608-844-8473",
            "fax_number": "608-400-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4785 HAYES RD STE 200",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537047364",
            "telephone_number": "608-844-8473",
            "fax_number": "608-400-8422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6502 Grand Teton Plz Ste 102",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537191047",
            "country_code": "US",
            "telephone_number": "608-827-7220",
            "fax_number": "608-827-7223",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1334 Applegate Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "53713",
            "country_code": "US",
            "telephone_number": "608-221-1500 x33",
            "fax_number": "608-221-1515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUGHMAN",
        "first_name": "LARA",
        "middle_name": "SKYE",
        "name_prefix": "Ms.",
        "credential": "LPC, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "15459-132",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5352-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSAC",
            "identifier": "15459-132",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "5352-125",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAC-IT",
            "identifier": "14277-130",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randy John Bouche, RN
• Lindsey L Boucher, CAA
• Jeremy Paul Boudreaux, LCSW
• Michelle Theresa Boudreaux, N.P.
• Shenikqua Bouges, MD
• Ian Brian Bould
• Robert Kenneth Bour, M.D.
• Suzanne Bourie, RN
• Christina Bouril, CGC
• Amy E Bourne, MD

• Professional Counselor in Madison, WI
• Providers in Madison, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.