Rachael Evonne Bolanos Jackson, TLMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

117723 Issued in IA

Practice address

4949 Pleasant St Ste 202
West Des Moines, IA 50266-5495

Phone

(515) 782-3208

NPI assigned

Mar 7, 2023

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780384867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4949 PLEASANT ST STE 202",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502665495",
            "telephone_number": "515-782-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4949 PLEASANT ST STE 202",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502665495",
            "telephone_number": "515-782-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS JACKSON",
        "first_name": "RACHAEL",
        "middle_name": "EVONNE",
        "credential": "TLMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "117723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117723",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Boehm, PHARMD
• Claire Noel Boehmer, DC
• Blair Boehnke, PA-C
• Britney Boland
• Riley Boland, PT, DPT
• Bold Behavioral Health, PLLC
• Lisa Ann Boldt, COTA
• Jennifer A Book
• Jennifer Renea Booth, M.D.
• Jenna Marie Borchers, PA

• Mental Health Counselor in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.